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.

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