MEDS REDUX

This is all my current medication. Of these, the Cialis, Mobic and the Micardis are not for psychiatric purposes. All the rest are for lifting, regulating, or otherwise controlling my illness.

MEDS

Every single day since I was first diagnosed (labelled, classified, boxed, categorised) in August 1979 I have taken some sort of medication for my condition, and sometimes a lot of it.

It’s a weird thing to get used to. When the stuff works well, you feel so good you don’t see why you should take it. Because you’re clearly fine, and you are prepared to fight anyone who tells you otherwise.

One of the many things about psychiatric medication is that not only does it work on only 50% of patients, is that they all have what’s called a “side-effect profile”. Sometimes you can be on a medication that seems to work very well, and you feel quite okay, except your mouth is always dry, and you have no saliva. Or which works well, but every time you stand up you get dizzy and nearly fall base over apex.

Or, if you’re on, say, lithium carbonate, which was my first psych medication way back when I was 16 and scared out of my mind, one of the things scaring you is that these big white tablets with the metallic aftertaste come with a requirement that you have quarterly blood-tests to monitor the level of the drug in your system, because it’s poisonous.

I was on lithium for a long time, years and years. It made my hands shake with a tremor so visible people would ask me if I was all right. And with that visible tremor comes a self-consciousness that makes you feel monstrous. That you’re a freak and a weirdo. Bad enough that you’ve been labelled “psychotic” (see previous post), but you are only too aware, all the time, that mental illness is not a cool thing to have wrong with you.

For one thing, it’s invisible. You “don’t look sick”. You look more or less fine. Someone else with a background in the world of mental illness might see the hand-tremor, the way your leg won’t stay still, the haunted and drawn look around your eyes, the way your pupils are either too wide open or too closed shut–that person will know who you really are. But to everyone else you’ll look okay, but perhaps you had a big night last night, eh?

Medication is a proper bastard of a thing, but better, in my opinion, than the alternative. And there are alternatives, especially these days. Medication, when it works, makes you feel more like yourself again. It might even make you feel like a better, upgraded version of yourself.

But for some people, it makes them feel blank or numb, or like they’re wrapped in cotton wool. It takes away all their feelings, not just the ones urging them to hurt themselves. For people in my line of work, the scribble caper, you hear of people worrying that medication will take away their way of writing, or distort their personality in such a way that their writing will be affected. Or, if they’re writing while taking medication, how much of what they produce is them, and how much is it the medication? People get extremely upset about this worry.

I’ve had six books published since 2004. I wrote all of them under the influence of medication. I also wrote another 15-20 books since I was about 18, all of which were terrible, again all under the influence of medication. I never worried too much about the drugs messing with my ability to write. For me, I could see that the drugs allowed me to write. They gave me enough clarity to use my creativity and artistic judgement so that I could, over time, improve my skills, such as they are.

I also know for a fact that mania and depression, distort not only your perceptions of the world around you, but also take away that sense of artistic judgement. Mania, in particular, provides boundless energy and excitement, and seems like the greatest, most amazing feeling ever, and you can write and write and write for days on end–

And it’s all crap. It’s just like when you have a really great dream full of brilliant ideas and insights, but when you wake up you realise it was all nonsense. The creative work you do under the influence of the illness (manic or depressed) is like those dreams, but you’re awake when it happens. Your artistic, critical faculties are simply not there. So you think all your ideas are fantastic and insightful. Not only that bit you’re funny, so funny! So funny, and for so long, that you wonder, idly, why people around are looking at you all uncomfortable and even a bit scared.

Some bipolar patients love the creativity burst that comes from the euphoria of mania and hypomania that they either refuse medication or they only take it sometimes. I have heard of people saying they simply can’t work while medicated. I’m not one of them, but I understand the point of view.

Other than medication there are other options for treatment. The one perhaps most commonly offered, usually in combination with medication, is the so-called “talking cure”, or meeting with either a doctor, psychologist or counsellor to discuss what’s going on in your life, your emotional state, and your troubles in general. Psychologists and counsellors also offer their clients much more time per visit than a typical psychiatrist can offer, which is good. The combination of medication and talk therapy can be highly effective, and I recommend it especially for people given to deep introspection and reflection, thinkers and artists of all kinds. Lately I’m seeing my psychiatrist each fortnight to discuss my medication regimen, and I see a clinical psychologist every two to three weeks for long talks about thoughts, feelings, memories. It was her suggestion that I try journalling like I’ve been doing.

Other unmedicated forms of treatment also include ECT (electro-convulsive therapy, which I’ve not tried), and a newfangled treatment “modality” called “rTMS”, or repetitive Transcranial Magnetic Stimulation. This latter I have tried, and am likely to be having another course of it soon (which I’ll report, if so). You sit in a chair that reminds you very powerfully of being at the dentist, and a machine on an articulated arm is positioned against the side of your head. The idea is that the machine produces an electromagnetic field which interacts with the electrical activity in parts of your brain, and brings about a therapeutic effect. You need up to 20 daily treatments, each one taking about half an hour. The experience is not unlike what a woodpecker attacking the side of your head might feel like. It’s loud, making a repetitive snapping or clicking sound, as each “train” of zaps occurs. It sounds unlikely, but this treatment has been shown to be effective for many patients, especially those for whom medication is not an option.

I don’t know how many medications I’ve tried in my life as a patient. First I was on lithium and a drug called Doxepin, but after several years the lithium seemed to have stopped working, and my doctor and I embarked on an epic search for a new combination of drugs (usually an antidepressant and a mood-stabiliser: this latter would prevent manic phases, while the antidepressant lessened the severity of depressive cycles). I tried all kinds of things over a long period. We worked systematically through the MIMS catalogue, trying to find something that would make me feel normal, while having the least intrusive effects. It was very much like what happened to me last year, only it took longer because I was an outpatient, so things couldn’t be rushed.

Because with these medications, it takes time to ease onto them, and further time to phase them out. If you start or stop suddenly you’ll be hit with diabolical side-effects. The point of putting me in hospital last year was to enable a faster approach to this than would be possible if I were an outpatient, since I would be in a safe, controlled environment with lots of support and staff monitoring how I was going. And yet, despite all this, it was hellish. First the full depressive cycle that was like a new full-scale breakdown just like the one from when I was a kid, then it turned out the new drug, Zyban, did nothing for me, leaving me still exposed in no-man’s-land while the doctors scrambled to find something else they could give me.

It took me a long time, when I was a kid, to adjust to taking medication every day, and especially on days when I felt fine. I didn’t understand the idea of “chronic illness”. That I would have good days and bad days. That you had to take the stuff, no matter what, to prevent hell-days.

Then one day I realised: it’s no different from diabetes. Diabetics take insulin every day to keep themselves going. People like me were the same. That did it. I stopped resisting at that point. The argument made sense.

The real problem is that bipolar and its related illnesses are physical illnesses, just like anything else, but they are known as “mental illnesses”. That qualifier makes them seem somehow less serious, less real, of less consequence than, say, diabetes. After all, “it’s all in your head”. But the fact is these are real, physical illnesses, as real as cancer, and in many cases as life-threatening as cancer.

One of the reasons I’m writing these posts is to help demystify the whole “psychiatric patient” thing. I’m a middle-aged man with a chronic illness. My medication is no different from what a diabetic would take. It’s a psychopharmaceutical walking stick. Imagine me gimping along with a walking stick. That’s me and how much I depend on my medication. It keeps me upright. Keeps me from falling over. And gives me a weapon, should I need it! 😉

HISTORY

[Note: this is a long post of 1740 words]

It was a clear bright August Monday in 1979, when I was only 16 years old, and I was scared out of my mind. My parents and I were sitting in the reception area of the psychiatric unit, ward D20, of Sir Charles Gairdner Hospital. We were waiting for a nurse to appear who would take me into the ward itself and get me acquainted with everything.

The waiting area was the sort of oppressive quiet that makes you feel guilty if you speak at even normal inside-voice volume. And in a place like this, a psychiatric unit, you feel doubly self-conscious, worried that people would hear you and know you for the lunatic you feel you must be in order to find yourself in this situation.

It didn’t look or feel like psychiatric facilities I’d seen depicted in movies and TV. There was a nice carpet and comfortable furniture. It looked more like a three-star hotel than it did like the kind of place featured in One Flew Over the Cuckoo’s Nest. I’d been expecting this latter, so finding this “nice” place was disorienting and stress-inducing in itself.

Some weeks before this, I’d been seeing a psychiatrist every week or so following what I was told was a breakdown back in June, when I’d been in a different hospital to have my appendix removed. One night just after the surgery (the appendix had been so inflamed it had been about to erupt into peritonitis) I found myself crying so much, and so hard, even nurses looked worried and scared. I remember it went on for hours. My mum was there as well as a nurse, and they got me through it. I still, decades later, don’t know what went wrong that night that led to this. I’d had some visitors come by, including friends from high school, and my folks, but some way into the visit I felt uncomfortable and stressed, and I asked if people would leave–and my next memory is lying there in bed howling like a baby.

In 1979 I was in my fourth year of high school, and I was in deep waters and couldn’t touch bottom. I was drowning, caught in a rip, and being dragged out to sea.

The first three years, I’d done very well in English, muddled along in things like Social Studies, and suffered horribly in Mathematics. In second-year high school I’d even failed Science altogether. I’d never seen such a thing before on a report card, a rude “F”. My parents were angry and mortified. I was humiliated, and felt a terrible weight of hot shame, that I carried into third-year, where I managed to do a bit better, but only a bit. The thing was, as happened when I was ten years old, and I had that day when I felt dead inside, I spent much of second-year dead inside, too. I remember sitting in Science class, just sitting, not listening, not writing, but sitting. I probably did this with my other classes, too, but I vividly remember my body occupying a seat in the Science classroom, but that I was only vaguely occupying my body. I was somewhere else, numb, remote, on the Moon. And I failed Science that year.

Back to 1979, two years later, when life in high school became much harder all at once. The first three years were like how primary school is to high school: all pretty slack and a bit of fun, but then things get a bit serious. In fourth year, things became deadly.

Fourth- and fifth-year were for kids who anticipated going to university after high school. Things became specialised: where we used to have “Science” we now had Physics classes and Chemistry classes, Biology and Human Biology. Where we used to have “Social Studies” now there was History, Economics, and much more. Mathematics metastasised into the numbered horrors of Maths 1, 2, 3, and 4–of which 2 and 3 were the most challenging, intended for advanced students only.

I had been assessed as being very bright, and a keen reader, so I was dropped into all the really hard stuff. I had Maths 2 and 3. Physics and Chemistry. History. And English (though not English Literature, a separate class). This line-up of classes was terrifying. I did not feel up to any of it, except English, which had been my great strength in the first three years of high school.

But the very first day of fourth-year English destroyed any feeling of security I had felt about my competence in that topic. The very first thing the teacher, a 30-something woman, said to us, perched on a stool at the front of the room: “Most of you will fail.”

She didn’t welcome us, showed no personal warmth. There was just this bombshell announcement right at the start.

And right away, sitting there in my grey poly-cotton shirt and grey cotton trousers, I felt something in me panic and die. I felt as if I had already failed. First I failed second-year Science; now I was going to fail fourth-year English. And English, of all things! The thing I was expected to ace! I was supposed to be good at this. By age 16 I was already a prolific writer, churning out vast numbers of truly-terrible science fiction short stories. I had entered and won the school writing competition a number of times (though had also often been the only entrant). I had decided, at 14, that I wanted to be a published author when I grew up. I was always reading, and always writing. Probably, when I was writing, I was also in a state of mania, my undiagnosed bipolar disorder enjoying a big upswing, manifesting as incessant typing.

Midway through fourth-year high school, in June, there were exams to see how everyone was doing. I was doing badly. I couldn’t do the mathematics, and I had no idea about the physics or chemistry. I had less than zero grasp of history (though it was interesting, at least), and in English I was drowning.

I did not know what to do. Sixteen years old, and doomed. I wasn’t going to university, and it was impossible to imagine anyone hiring such a dunce as I clearly was.

Oh, and there was bullying. There was bullying from other students, and there was bullying from teachers. Kids informed me early and often that I was fat, gay, sexually repulsive, dirty, unmanly, and useless in all respects. Certain of my teachers took the opportunity to inform me that I was dull-witted, a disappointment, and incompetent.

Then there was my dad, the poor bugger who was dealing with his own untreated bipolar condition, who didn’t understand why his bright, articulate, brainy son was struggling so much with school. I would get 8/10 for an assignment, and Dad would demand to know how I lost those two marks. Nine out of ten, the same routine. Ninety-five percent? How’d you lose that five percent? He thought he was being encouraging. All these decades later, he doesn’t even remember any of this. It’s strange, having a grudge against someone who has no memory of the events in question.

And, on top of all this, I was floundering so much in school in every subject that every night I had hours and hours of homework, sometimes as many hours of homework as hours I’d been at school. Grinding away all evening until a late bedtime, and even up early to squeeze a bit in before pedalling off to school for another day of abuse, confusion and despair.

In hindsight, the only real question is how did I hang on so long before that breakdown? Mum and Dad knew I wasn’t right. Two years before, when I was 14, the year I failed Science, the year of sitting and staring, they took me to a doctor, a specialist, who told them (I only dimly remember this event; what I know about it mainly comes from Mum) that I very likely had what was then called “manic depression”, but that for some impenetrable reason nothing could be done in the system until I had some kind of breakdown.

But once I had said breakdown, we were off to the races, so to speak. The whole rest of my life as a psychiatric patient began to unspool. In Sir Charles Gairdner Hospital, where I stayed as an inpatient for four months, they ran all kinds of tests, interviewed me a great deal, and encouraged me to follow a program of various kinds of group therapy, as well as other more recreational kinds of groups. The doctors sat me down fairly early on, and informed me I had this condition, a “bipolar, biochemical, affective psychotic disorder.”

This was devastating. Psychotic? The word leapt out at me, wild-eyed, with a knife in its teeth. Nothing good came from that word. It was the 1970s. There were terrorists who were sometimes called psychotic. Mad bombers were psychotic. Psycho killers were psychotic. And I was 16 years old with a vivid imagination. My life, I saw, was over. Who would marry me? Who would even go out with me? Who would have me at all? This fat, wretched, pimply, nervy guy–this psychotic?

Flash-forward 38 years, and I’ve been married 24 years to the wonderful Michelle. She took me. She had some idea of what she was getting, having had “my sinister secret” explained to her by not only me but also my doctor at the time. I made sure she was as fully prepared as possible.

And for almost all that intervening time I managed with just doctor visits and medication. I managed okay, well enough. I even managed to get some books published, and establish a dimly glowing pilot-light of a career as an author.

But the psychopharmaceutical wheels fell off in the past few years, and I slumped into a deep despond, which, last year, prompted my current doctor to suggest I “come into hospital for a medication change”. He said this would take maybe two weeks, in and out, no different from putting your car in for a service, up on the hoist, everything checked out.

A year later, I’m still up on that hoist

TOO MUCH INFORMATION?

Am wondering I should change my site name to TOO MUCH INFORMATION, considering what I’m writing about. If you have a view, let me know, please!

Also, I’m working on adding a page with links and details about my published books so far, and how to find them.

Is there anything else I should add?

A YEAR AGO TODAY, IN HOSPITAL

This is a piece I posted on Facebook a year ago today. It was a few weeks into my first hospitalisation, and I had been taken off one of my major antidepressants, and waiting for a new drug, called Zyban, to come up to therapeutic levels. In the meantime I was experiencing a full depressive cycle.

“Have had big chunk of medication, and am feeling more okay again. Was extremely bad there for a long while.

<an hour later>

You guys! I’ve just had the longest, most interesting, and kind chat with a nurse, who came down to see if I was okay, and who helped me talk through how I’ve been feeling, etc. (We also shared grumbles about the food situation.) A truly lovely, friendly chat. Could only have been improved with a coffee with a scenic view. I feel so much better (though that could be heavy-duty meds kicking in). Am all agog at how nice that was. 🙂

Ping Michelle Bedford; Marie Bedford. I’m sorry for worrying or upsetting you, but I was having the worst experience I’ve had in years. I will be talking to the doctor tomorrow about what this means in terms of the trial. Though the fact that I’m now clear of the Clomipramine but not yet at therapeutic levels of the Zyban suggests I might just be crawling through the barbed-wire no-man’s land between the effectiveness curves of two medication regimes.

Anyway, thank you, all, for listening to me tonight. It’s proving much harder a gig than I ever expected.

Oh, and you know what feels really quite strange? You’re walking around the corridors and riding the lift, trying to sort all this out, whilst feeling as though you’re going to melt down if someone so much as blinks at you–but random strangers still compliment me on my monster slippers! “Thank you,” I say, all voice of a ghost, and shuffle on.”

This conveys some of the wretchedness I went through. That was a very bad day indeed, featuring a great deal of crying. When it says I was having the worst experience I could remember in years, I wasn’t kidding.

TESTOSTERONE

Today I visited the “men’s health” doctor for a fortnightly checkup, and to get my shot of testosterone. Every two weeks, a huge injection in my backside.

Because it turns out that when you are depressed, as I was for at least a few years before embarking on last year’s straightforward-seeming “medication swap”, you take a great deal of medication to help you balance your moods and emotions. And when your doctor proposes a new medication, you get an information handout about it which lists, among all kinds of amazing facts, known side-effects, rated from most- to least-common and even rare. The rare ones are usually deeply scary.

But a common one that often appears with these drugs is sexual dysfunction of one type or another. This can manifest in all kinds of ways, including simply making you feel like a mouldy potato starting to grow roots while it’s in the cupboard. You feel cold, inert, and repulsive. You want to hide your physical self. You no longer get anything resembling the sexy feeling that drove you nuts in high school, and you had to always have a bag, or a jumper, or something you could use to hide your unasked-for hard-ons. At the time, your biggest problem is that you feel horny as hell, but you can’t do anything about it with anyone, because you’re a spotty, poxy, teenage boy who smells to girls like a goat. It’s frustrating beyond measure, beyond believe, and brings with it a whole torrent of anxiety all its own.

But suppose instead you’re a 50+, overweight, middle-aged, middle-class guy who never feels like that anymore. Who has become that potato in the cupboard. Who is full of deep self-loathing. Who misses his former self. Who wants nothing more than to be a good husband and partner. Imagine that was gone, as if amputated. Imagine the howling silence in your head where you used to think about sex every few seconds or so.

This is one of the very worst aspects of the medication prescribed for mentally ill people. It can restore a great deal of “feeling normal, or even better than normal”, but at great cost. The two big typical side-effects of psychiatric drugs is sexual dysfunction and weight-gain. Between them, these two come with giant helpings of prickly anxiety and often a form of depression (just try to imagine the sense of shame you might feel) just from how your feelings make you feel.

Last year, during the six-month period in which I was hospitalised three times, each for seven weeks (a coincidence), my consultant psychiatrist, head of my team, suggested I try testosterone in addition to my other “meds”. By this point I was up for anything that would make me feel less broken and useless, a forgotten doll of a man complete with weirdly-blinking eyes.

Testosterone, my doctor told me, is not only good for one’s sexual health, but is a “master hormone” involved in the function and regulation of a great deal of one’s mouldering potato body. It also, he told me, seems to boost the effectiveness of the other drugs you’re already taking. Something like adding nitrous to a car, maybe. Maybe.

Upshot: it’s good stuff. It works. In hospital last year they had me on testosterone tablets, but not enough of them (in tablet form you need to take eight per day), so they had little effect. Since then, under the care of the men’s health doctor, he has had me try using a topical cream applied, let’s say, “south of the equator”. This you have to do every night, and it’s icky, and I often forgot, which in turn led to failure to see much result. I now get these injections every fortnight. And, at long last, my blood testosterone level is normal, even great!

And, let’s just say, I am starting, though it’s very early days yet, to feel less like an old potato.

ANXIETY ON SCREEN: Wallander

Last night I watched an episode of Wallander, the BBC series featuring Kenneth Branagh in the role of Henning Mankell’s Inspector Kurt Wallander.

I’m a Wallander tragic. I’ve read all the books, and I’ve seen as much of the related TV work as possible, including the Swedish language spinoff TV series featuring Krister Henriksson, and the earlier, more faithful Swedish TV adaptations of the books featuring the man who owned the part like no-one else, Rolf Lassgård, my favourite screen Wallander.

I’ve always felt that Kenneth Branagh was wrong for the part, but I’ve watched his takes on the character now many times, and over many viewings I’ve come to grimly accept that he’s never going to be Lassgård, no matter how much I might wish it so. For one thing, he looks much too “together”, even at his shabbiest. He looks too put-together. Usually, at least.

But last night I was watching the adaptation of book three in the series, The Man Who Smiled. It’s, in my opinion, the weakest of the original novels, with an organ-trading rich bastard who is so plainly and calmly evil he could be a Bond villain. I was shocked, reading the book, at how awful a character he is, how almost comically bad, how two-dimensional. And in this TV adaptation, the actor does his best with the part, which doesn’t ask for much other than cool, calm, smugness, a glib sincerity that in the beginning Wallander finds disarming, and even admirable.

But, what’s truly striking about this adaptation is what’s happening with Wallander himself. In the previous episode, he’s for the first time in his life killed a man in morally complex circumstances, leading to what appears to be a complete mental breakdown. He went on indefinite sickleave to a faraway guesthouse near a wintry beach, and Wallander spends, we’re told, six months just standing on the beach all day long, lost in depression and crippling anxiety. Indeed, at the beginning of Smiled, he’s approached on that beach by an old friend who’s concerned about the circumstances surrounding his father’s death. He wants his friend Wallander to look into it, but Wallander turns him away, a shattered man who knows he’s not up to it.

But of course events lead from one development to another on a familiar road of plot (broken man finds wholeness and redemption in work), and soon Wallander, shaking and sweating with anxiety, is on the case, trying to figure out what happened. He’s a detective in not much more than name only. He shakes, and slouches; he sweats and stammers, and barely even speaks or looks anyone in the eye. He sweats so much during his presentation of mysteriously suggestive evidence to his former team that afterwards, slinking back to his office after everyone tells him he’s got nothing, and treat him almost with contempt, he wipes his sweaty armpits on his office curtains.

I’ve seen this episode a few times already, but watching it last night, in the wake of my own recent struggles with major anxiety and depression, I saw it as if for the first time. Wallander is a desperately sick man, barely able to function, as sour and useless as the expired and mouldy food in his unpowered fridge.

This episode, despite the whole organ-trafficking storyline, does a spectacular job of portraying anxiety and depression. It’s unrealistic that Wallander is back to his old self by the end of the episode. In the books his recovery takes longer, and the traumatic memory of shooting a man continues to haunt him for the rest of the book series. But in this TV adaptation, Branagh, who has always done intensity well, makes a convincing anxiety sufferer. The actor has either known it himself, or has studied it closely. I was amazed, watching it, the sheer subtlety of his performance, the minimal touches in the way he carries his body, the way he speaks, movements of his head. It’s an amazing thing to see, at least for me with my own recent experiences.

DEAD INSIDE

One day when I was about ten years old, I believed I was dead. It was a bright, warm day, the sun beating down. It might have been a Sunday, but am not sure. I have few details to go with this memory, other than that cold, numb sensation that at the time, I thought, could only be death.

I’m reading about the writing of memoir lately. Ever since my experience last year in hospital, I’ve been nursing the thought of trying to write down the story, if I call it a story, of my life with mental illness. But the more I think about the prospect of sitting down to work on it, it seems to recede in my mind, as in the sort of dream where you run towards a point up ahead, but that point telescopes out in front of you, a sarcastic version of Zeno’s Paradox, where not only can you never beat the tortoise to your destination, the destination gives you the finger and runs away.

So, writing a memoir about my life living, as if with a terrible house-guest, with mental illness, bipolar disorder, in my case. Where to begin? The memoir-writing book I’m reading at the moment, Beth Kephart’s Handling the Truth: on the Writing of Memoir, suggests, before you very seriously sit down to Begin the Memoir, perhaps instead you should, sort of, ease your way into it, as if perhaps it’s a party and you don’t know anyone there, with journalling. Which is why I’ve been using my website lately. This is me working my way up to writing a book about my life with a terrible house-guest sharing my head, and messing me up.

Kephart suggests lots of exercises to limber up your writing muscles, to start thinking like someone writing memoir, and I’ll be trying some of them here in the near-future. But the one I’m doing today is the recommended exercise of trying to write down your first memory.

My first memories are elusive and fragmentary. I hardly know where to begin with them, other than perhaps as random blurry snapshots not to be taken at all seriously. But considering my overall goal, I thought it would be good to try to describe my first remembered experience with depression.

Looking back from my middle-aged perspective, I can see things from my pre-diagnosis past that look like episodes, or instances, of depression. The first that I can think of was this one where one Sunday when I was about ten years old I suddenly realised, as I lay in my bed that day, a feeling upon me of being far away from my life as I had so far understood it. I was just a kid, and I was used to odd things happening–that was life: practically everything that happens is new to you. And this feeling was new. New and strange.

I felt as if I had died, that I was in fact dead, but because I was already lying down on my bed hadn’t fallen over. That I was awake and conscious seemed weird, but not overly so.

What was I doing before that? I have no true idea. The memory consists of only the details I’ve described. I don’t even know what happened after that. I have a vague and therefore unreliable recollection, possible fabrication, that my mum appeared in the doorway and asking her if I was dead, but I don’t know. I felt numb and, as they would say today, disassociated. Separate from myself. As if looking at me from the outside. Not sad, either. It was like a freedom from feeling. Numbness. Blankness.

I’ve experienced that again many times over the course of my life, up to and including this past week. Depression is like this, like your heart has been removed. Like you’re a lump of something inert and lifeless. And like you’re far from home, perhaps on the Moon, and made of the same arid grey stuff.

DOCTOR VISIT

Today’s visit with my psychiatrist went well. Things are in motion. First up, I’ve been given a referral for a sleep-study, to see if there any problems there that might be contributing to my alarming weight-gain. As well, he has sent me for a blood-test to see if the Nortryptaline is at the right level. The concern is that it might be too high. He also doesn’t want to mess with a drug that in other ways is working reasonably well, considering the extraordinary difficulty I went through last year in hospital.

I also asked him, essentially, what else he had, treatment-wise, besides medication. I said I’d even consider ECT if he thought it might be of benefit. He isn’t too keen on that, but he did ask how I’d feel about trying rTMS (repetitive transcranial magnetic stimulation) again.

I was introduced to rTMS last year, and did not like it. You sit in an uncomfortable chair that reminded me too much of a dentist chair, and there’s this machine against the side of your head that makes these loud clacking noises, and there’s a physical sensation like a woodpecker is attacking your head. Last year, I endured just three sessions of it, hated it, and withdrew my consent.

But now I feel different, generally speaking. I’m up for trying it again, and that would mean being hospitalised again, since the treatment is, as the name says, repetitive: a total of about 20 sessions, one a day except Sundays. It’s a very daunting prospect, but potentially it could mean much less medication.

And speaking of medication, depending on how my blood-test results go, he’s thinking of replacing one of my medications, Latuda, with Topamax, which should help with anxiety, and possibly help with the weight, too. He’s also thinking about a drug called Duramine, about which I know nothing, but which he thinks could also help. The only thing I know about it so far is that it’s some sort of actual stimulant, which is a little troubling.

This all seems pretty daunting, just looking at it here, but it troubles me much less than everything I endured last year, an experience I would not want to repeat. For a while there I had no effective control over my bipolar condition, and suffered a full-on depressive collapse. I did not know until later that my doctors were shocked at the severity of it. The plan had been that I would be weaned off the meds I had been on for about 30 years, and eased onto a new drug, called Zyban. But the Zyban had no effect on me, bit by the time that was apparent I’d been on it long enough that there would be problems cutting it off quickly, so had to endure the weaning off period for that on top of weaning off the original drug (Clomipramine, a nasty tricyclic antidepressant).

Fun Fact about psychiatric medication: any given drug, even the shiny and sleek new ones, have only about a 50% chance of working on any given patient. And with the Zyban, there was simply no clinical response. Which is to say: I could not stop crying. I had a world of trouble sleeping. Michelle or my parents would come to see me, and I’d bawl my eyes out every time they left, and often while they were there. It was awful. It felt shameful. Sitting on the toilet in my room weeping buckets, because it was the most private space I had. And all this because of tiny things measured in milligrams. How could such tiny, birdseed-sized things, cause such all-consuming storms of wrongness? Because it always felt, and to this day continues to feel, like a terribly wrong thing, to cry.

But that’s a story for another time.

APPREHENSIVE

I’m watching Korean TV while Michelle’s making a Korean soup (rice cake soup), and it’s nearly 7pm. I’m preoccupied, though, because tomorrow, Monday, I’m seeing my psychiatrist for a review of my current treatment plan–and the problems I’m having with it.

The main issue is that I’m taking 150 mg of Nortriptyline, a tricyclic antidepressant, and while it does a good job of balancing my mood, it’s having a catastrophic effect on my weight. Nortriptyline’s side-effects include not only weight-gain but also increased appetite, and I’ve got both these things in spades. It’s also given me an extremely sweet tooth, so that I’m always wanting to eat very unhealthy things, and this turn has a drastic effect on things. Since I left hospital in November last year, I’ve regained 10 kg out of the 51 that I managed to lose since December 2012.

I’ve had misgivings about the Nortriptyline since the beginning, because I knew up front that the drug would have effects like this, but for a while it appeared to be doing a decent job of balancing my mood. But all that time, my weight was climbing, and as it climbs, my mood sours in inverse proportion, which in turn leads to unhealthy, emotional eating, sometimes to the point that I don’t care about my weight. Which tells me I’m deeply troubled, to say the least.

So I want to look at possible changes, up to and including coming off the Nortriptyline altogether and trying something else, if there is anything else, or maybe try other sorts of treatment, like maybe ECT, which, while a daunting prospect, is reputed to be highly effective.

My doctor also floated the possibility of starting me on Topamax, an anti-anxiety medication which has the very striking side-effect of weight-loss!

The only potential problem here is that I spent almost half of last year in hospital trying to sort me out with new medication (which is how I ended up on Nortriptyline), and it was a harrowing experience in which I tried a great many things, most of them unsuitable, before going on the Nortriptyline. The experience (withdrawal, anxiety, full depressive cycle, some manic cycles, you name it) was so bad I can’t see my doctor being keen to do all that again.

So I’m apprehensive about tomorrow. I know I’m not yet remotely recovered from last year–I am depressed and anxious as I write this, but I feel a great need to do something to arrest my climbing weight. The way things are going I could end up putting back all the weight I lost, and more, before too long. It’s just about all I think about, my day organised around the daily lunchtime weigh-in.

So am hopeful, but fearful, about tomorrow.