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Bipolar Recovery Update 3

So continuing on from Part 2, I was still in Nashville, I’d done the initial intake with a counselor, psychiatrist and nurse practitioner, gotten some sample pills of Depakote and started treatment.  That’s where we pick up.

Note: I want to make it very clear that everything I’m going to talk about is meant to be descriptive NOT prescriptive. This is simply a look at some of what happened to me, what’s happening now, etc. So don’t read anything I’m writing as a recommendation for self-treatment or anything like that. This is only about me.

Starting Depakote

I had been instructed to take Depakote at bedtime to help with my sleep.  And it had the entirely opposite effect.  I went from broken sleep to wide awake, no way in hell are you sleeping non-sleep.  I tried it the second night, same effect and I called the nurse practitioner (NP).

She said to take it earlier.  So I moved it back in the day and back in the day and finally to morning.  My sleep still sucked and I was getting horrible headaches and what I can only describe as pressure behind my eyes.  Especially when looking at a TV and worse yet when the background was white or bright.

As an experiment, I (probably unwisely) dropped the meds for the weekend to see if the side effects went away.  They did and I slept better.  And took it again on Monday and they came right back with awful sleep.  My followup with the NP was Tuesday and I was basically done with the depakote.

At the support meetings I had asked some folks about depakote; while I don’t honestly personally get much out of “support groups” per se it was useful to have folks with years (3-30) experience with meds and responses and I was way more interested in the technical stuff.  And honestly nobody there reported a good experience with Depakote.  It seemed to be the first drug everyone was given and nobody seemed to get much out of it.

I had heard stories of people taking months or years to find the right meds, or combination and this is quite common in mental illness treatment: what works on/for someone does nothing for another.

And I wanted it fixed NOWWWW.  Yes, Veruca.

The Apology

It was about this time, after the first of the year that I would offer up my Internet Apology and “come out” about all of this.   I told my therapist about it and considered it to be part of my recovery.

He mentioned the Alcoholics Anonymous idea about “making amends” (which I was aware of) which usually involves more than just verbal apology but I noted that most of who I’d dumped on were Internet people and apologizing was my first (and for most of them only) step.  The rest would be a concerted effort to change my behaviors.

He seriously noted that my considering this a recovery was a good attitude to take about it.  He didn’t expand on that but, as I think about it, I guess it’s that recovery implies an ongoing process rather than there being some concrete time when it’s all cured or whatever.

In any case, the response to that piece, to put it mildly, was overhwelming.  Between hundreds of emails with lots of good advice and support to people just sharing their own experiences (themselves or with family members), the response was huge.

Mental health tends to carry a real stigma and there is often the mindset that you’re suffering alone and in silence and/or are the only one and hence you suck (roughly).  But as soon as someone speaks up, everyone feels like it’s ok.  I think that’s part of why support groups are so valuable for some people, it’s a safe place to discuss their issues and they get to see that others are going through the same challenges as they are.

A couple of other very good things came out of it as well.  A good friend of mine reached out to me about his own depression (his first one which meant he had no context for it) for support and information; an old childhood friend, who had been self-medicating, had also come out to their family about some issues and wanted to get proper help.

Kind of like with my writing about the dogs previously, whatever influence I or my site have had done a lot of good and that certainly didn’t hurt my response to putting it out there (trust me, I waffled for days about hitting publish on that piece since I wasn’t sure what the response would be).

The Followup

I’d have a followup with the counselor (which went well, no real details to report although it was kind of like chatting with a buddy) and then the following week both an appointment with the nurse practitioner and the counselor on the same day.

I’d take my blood work to show them, nothing really showed a problem (though my testosterone, last measured in my 20’s was still a wonderfully low 295; the “normal” range is 300-900) although she wanted my Vitamin D status a little bit higher (it was 42 which isn’t terrible but she wanted me in the 50’s).

We’d also go over the genetic tests.  The first big flag was a genetic variant having to do with folic acid conversion to methylfolate.  Apparently I carry a gene variant that means I make the conversion something like 40% less than others (a double gene variant puts conversion like 70% down).

Folic acid can’t get into the brain and since methylfolate is involved in neurotransmitter synthesis this is thought to be part of the problem in mental illness.  A company actually makes a high dose methylfolate supplement called Deplin and she suggested I take it (my counselor said he had seen cases where Deplin alone fixed the problem which sounds lovely).  It has to be prescribed but she knew of an online company that could get it to me a little bit cheaper.

I also had another variant that had to do with liver metabolism and apparently I am a hyper rapid metabolizer (yay me?) which has consequences for dosing of certain drugs and such (I either need higher doses or more frequent dosing of certain things).  Everything else was normal at least within the testing Genomind does.  They look at a host of factors, I just didn’t carry any of the variants that mattered.

She’d switch my medication to Lamictal (lamotrogine) another fairly common mood stabilizer.  She didn’t have samples so she wrote the script, followed up on the activity, diet, fish oil and Vitamin D thing (I was religiously back on all of it) which was all on track and we scheduled a followup for a month hence.

Lamictal, due to a rare fatal rash in a small population, has to be ramped up in dose over about 3-4 weeks so there was little point in following up sooner than that.  It wouldn’t have an effect before then.  I did get a little bit of the same headache and eye pressure from it so that may just be part of the drug class.

Given what I sense to be problematic adherence with this stuff (mind you, when you’re depressed it’s hard to do any of it) she seemed impressed at how quickly I’d gotten back on track.  But most of it was part of my past habits anyhow and I’m nothing if not determined.  I wanted this dealt with and that meant doing it correctly.

This was also when I voiced that one of my issues in terms of life structure was my lack of socialization (well, healthy socialization) and she recommended the site to me that I mentioned before.  She asked me if I still felt depressed and I told her I wasn’t sure if it was that or just boredom.

Most of what I was doing in Nashville was watching a LOT of TV and playing on the computer.  I didn’t even have my trusty PS3 to kill time, Candy Crush Saga was just annoying me, and there wasn’t anything I wanted to read.  I couldn’t run the dogs and I was stunningly bored.

The Next Couple of Weeks

At this point things felt kind of stable; it was like the second week of January now.  The new meds weren’t hurting my sleep, I was getting to the gym semi-consistently, although my food intake (a lot of high-carb night eating) was simply still off the rails.

I had gotten a small light box and used it for 30 minutes as I worked at the computer in the mornings as well.  I’d find out later that timing is absolutely key for this and due to my own physiology, I’d need to use it at 5:30 am so that went out the window.

Thankfully, some of the aftermath of the hypomanic phase was starting to wind down and my stress was relieving itself little by little.  It didn’t look like I was going to be in as bad a situation as I thought.   It wasn’t great by any means but it could have been far worse.  I was able to get a good bit of the financial stuff at least dealt with and that was another huge weight off my shoulders.

About this time, I actually started doing some work.  Which is kind of novel for me of late.  Specifically, I had started looking into the Kindle platform on Amazon again and started working on reformatting my books.  No, they aren’t available yet so stop asking.

I actually made sure to not do too much on the Kindle stuff in a given day.  I’d get a couple of hours of work done in a day and then stop and go watch more Law and Order: SVU.  It felt good to accomplish something but I wasn’t letting myself get overwhelmed by trying to do too much at a time.  I worked when I felt the urge and didn’t when I didn’t (without feeling guilty about it).

I’d gotten on the Meetup site and looked for some activities in Nashville.  I actually had planned to go to one but it got cancelled which bummed me out.  I was still having a weekly meeting with the counselor and going to the support group meetings regularly at this point.  It was at least a little bit of structure in my week.

Going to the support group would somehow make me feel guilty at this point.  Between seeing how much awfulness others were going through and reporting their challenges (we’d all share our week in terms of good or bad things that had happened) that mine was actually going well made me feel bad.

My mom made the point that other folks doing well HELPS the ones doing poorly; it shows them that it can get better.  My therapist pointed out that my experience was still my experience and not to discount it.  I still managed to feel guilty for making progress in what felt a fairly rapid way (mind you much of this could just have been my normal swing out of depression but I’ll still take it).

In terms of finding other activities or outlets, my counselor had made the point about my maybe or maybe not being able to do any sort of activity without becoming obsessive about it whether it be my previous field/obsession or something new.  I told him it had never happened but we’d see.

I had brought up the idea of volunteering again but he told me to wait until I had stabilized and had narrowed the road a bit.  He entreated me to actually wait to get involved in too much, as he put it “I don’t want to see Lyle on the news after 36 hours at some volunteer project.”  Fair enough.

Moving Forwards

At this point I was in a bit of a quandry.  About a month had passed in Nashville and while I was getting something out of the support meetings and the counselor, I was getting itchy to get back home and my normal schedule.

I felt pretty stable, I was getting work done and felt productive.  I was back in the gym.  I had already looked up support meetings in Austin as well as stuff with a focus on nerdy gaming type stuff.  I told my counselor that it was within my wheelhouse and would get me started without jumping into the deep end.  It would also give me a, shall we say, healthier social outlet than I had been involved in previously.

I had also basically cut off all contact with people who were, objectively speaking, not healthy for me to be around.   While I’m not addictive I am obsessive and there are certain environments that I’m not good at handling. I can’t even be around them a little bit so, just as I’d done in my 30’s, I cut it out of my life.  There was one exception but that’s neither here nor there.

Honestly, I didn’t really feel that it was useful hanging out in Nashville for a couple more weeks waiting for the followup with the nurse practitioner with the new meds (that seemed to be working as well as anything at this point).  While not ideal she said she could followup via Skype and she was able to switch my prescription to Austin. That was easier than trying to find someone new in Austin anyhow.

Going back to Austin

So late in the about the second week in January, I made the decision to go back to Austin.  I figured, worst comes worst, I could just come back to Nashville if I started to crater or go off the rails.  The biggest hassle was with the mail forwards but that was pretty minor in the big scheme of things.

I’d leave Nashville on a Thursday and be back in Austin that night; I wasn’t sleepy so I just powered through. The biggest hassle was that my furnace had crapped out before I left.  Figuring “It never gets that cold in Austin” I hadn’t dealt with it.  And we were in a freezing cold snap.  Good times.

I’ll be honest that, after a month away, it felt really weird to be home.   I can’t really explain why but it did.  But now the real test would begin.  I still had little support here, a fair amount of other baggage from my previous years here and some major cues for some really bad habits.  I had started the process of recovery but knew full well how easy it is to fall right back into problem territory.

You’ll note that this is being run earlier in the week than the last two updates and that’s so I can run the last part (for now) on Thursday.  And that’s because I have an announcement for next week and I want to get to it sooner rather than later.

And that’s where I’ll stop today.

Next up, Bipolar Recovery Update Part 4.

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