The Medication Rollercoaster

bipolar medication rollercoast
Sometimes you wonder which is worse...the disease or the treatment.
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I felt like I was high on good drugs all the time. Caffeine sent me soaring into euphoria and I was unstoppable. Something wasn’t right. When I went to my doctor in the summer of 2018 to try antidepressants for the first time, I expected a take a little white pill for a little while. I ended up with mania, a diagnosis of bipolar disorder, and a lifetime of treatment.

I had my first bout of depression in the fall of 2000, but I avoided doctors. Mental health wasn’t really talked about back then. Not in school, and not often at home or with friends. I felt there was a stigma around mental health issues and wondered what my future career and social life would look like if I came out of the shadows. In my head, people avoided psychiatric medications because it’s akin to announcing, “my brain is broken.” What other reasons could there be?

I moved across the country to party hard to forget my woes. Booze, drugs and dancing kept me preoccupied for a while, but when I returned home to go to school, the depression returned.

Throughout the 18 years that followed, I saw several councillors and doctors who offered me medication, but my brain was hell bent on clutching the old stigma. This time I chose exercise and meditation. Cognitive Behavioural Therapy (CBT) helped me make some sense of what I was feeling, and gave me new skills for my depression toolbox. But the depression kept coming back.

It all came to a head in 2018. I lost interest in all activities. I couldn’t sleep or concentrate. The daily interaction with coworkers drained my energy and I had none left for chores or regular showers. My mind was spiraling out of control and I was obsessed with negative thoughts. I drank booze and smoked weed alone on the sanctuary of my couch.

I was so irritable and impatient that every tiny obstacle in my way became a complaint. Every complaint became an obsessive thought. Every obsessive thought wound me tighter and tighter until one morning I couldn’t hold it all back.

In what I now call “the commuting incident,” I was biking to work to give a big presentation. I was running late, and livid with myself for not planning better. I had zero care for people and vehicles in my path. Two large red transit vehicles narrowly missed me, horns blaring. I nearly flattened an elderly woman as I sped through a stop sign.  When a pedestrian yelled at me in the woman’s defence, I struggled to fight the overwhelming urge to hop off my bike and punch her in the face. This wasn’t the first time I’d had to stop myself from potential violence, and frankly it scared the crap out of me.  It was time to let go of the stigma I held for so long, and see my doctor for medication.

Near the end of June, I was prescribed an antidepressant called Lexapro. It eases depression by increasing the amount of the happy chemicals, like serotonin, in the brain. It was effective.

It was too effective.          

My mood went from low and lethargic to hyper, and euphoric. The euphoria was better than any drug I’ve tried. I started many fun projects around my apartment and abandoned them without prejudice. They still haunt the halls of my home today. I thought “Wow! This is what normal feels like? People feel like this all the time?” I wondered why it took me so long to try this magical white pill. Any remaining stigma was thrown straight out the synapses and I now struggled to understand why anyone would go off their medications.

These new feelings progressed and then agitation set in. I’d snap with irritability directed at anyone in my way. No one was safe. Not my friends, not coworkers, my dog, or strangers. I’d laugh one minute and sob the next, or both at the same time. I began to wonder if something was off.

The warnings in the Lexapro pamphlet were pointing to mania. For some people, antidepressants flip a person’s mood from depressed to manic. This sudden switch in moods is rare with unipolar depression, but is found to affect around 14% of bipolar patients. Mania can escalate into a serious medical episode including breaks from reality. This is called psychosis and as a single woman living alone I was terrified to think I could slip from reality and no one would know. How long would it be before someone realized I was wasn’t around?

I was back to my doctor’s office by mid-September. She prescribed Abilify, in addition to the Lexapro. Abilify is in a class of drugs called second-generation antipsychotics (SGA). SGA drugs are used to control bipolar depression and protect against mania. An urgent referral was sent to a psychiatrist.

My first psychiatric appointment was mid-October, 2018. There is no single test for bipolar disorder. My appointment began with a long survey on past behaviours including drug and alcohol abuse, and bouts of depressive and manic symptoms. I had several “A-HA!” moments when filling out the survey. I knew my depression ebbed and flowed but I had never crossed my mind between those ebbs I occasionally had mild manic episodes. There were simply times in my life when I was hyper-productive and social, when my sex drive was bonkers, and I could hardly keep my mind focused. I just assumed this was life. I didn’t know any different.

The survey was followed by a 40-minute interview with the psychiatrist. Through the questionnaire, the interview and my recent history of antidepressant mood switch, I was diagnosed as bipolar.

There are two types, cleverly named bipolar type one disorder and bipolar type two. My psychiatrist has mentioned a couple times in passing that he thinks I’m type two. Time will tell if I’m ever upgraded to bipolar type one, but it’s unlikely as my symptoms of mania are more in line with the less intense type two variety, called hypomania.

Medication number three, Latuda, replaced the other two medications.  It’s a drug that is also used for psychosis, but it gives bipolar patients long term protection against future depression. After coming down from the Lexapro high, my depression and unstable mood worsened. I couldn’t concentrate on work, and a part of me was kicking myself for even mentioning the mood switch to my doctor. I missed the euphoria. The depression ached in my bones, and I wanted to stay in bed forever. In early November, I was prescribed another antidepressant, Trazodone, but when medication number four didn’t help, it was stopped and the daily dose of Latuda was bumped up.

It had only been four months that I had been on this journey but it felt like 40 years. Four medications had driven my mood all over the map and I was back to where I started. I questioned why I was putting myself through this.

I wondered if this is why people stop their meds. A negative attitude towards medication is listed as the third most common reason a patient stops their medication in a review done by the University Of Texas Department Of Psychiatry. The fourth is medication side effects.

By late November my daily Latuda dosage was raised to 40mg a day, and a new side effect was triggered. My anxiety went from mild to an all-time high. Each day at work, I’d sit with a resting heart rate fit for a light jog.  I would dab my sweaty palms on my trousers every few minutes, and my socks were soaked.

I had the irresistible urge to move my feet, legs and hands two hours after taking my Latuda. Moving was the only thing I could do to soothe the storm of restless energy building up inside me. Though it sounds like a job for the gym, my brain was whirling with an endless stream of thoughts. I couldn’t focus on anything. In my non-medical opinion, it felt like the side effect called “akathisia”. It is a state of mental agitation that causes an urgent need to move, often with restlessness legs.

I felt like I wanted to crawl out of my skin and I could no longer make it through my work days. I would lie on my couch and fidget, hoping for it to subside so I could walk my dog. I piled several blankets on top of me so the weight would keep me from bursting. The feeling would never leave; only recede enough so I could function until it was time for my next dose.

My psychiatrist didn’t take me off Latuda. Instead, medication number five, Seroquel, was added to help combat the restlessness. It’s an SGA with a pleasant side effect of sedation. I was getting better sleep but I woke to the same dread of the stress to come.

I stopped cooking my own food, and I stopped seeing my friends. I was tired from social engagements before they even started. My thoughts obsessed that there may be no help for me, this is my life.

I wanted to quit and get off these drugs. How could this be any better than the disorder? A friend of mine stopped anxiety medication after a few days due to unbearable headaches. He didn’t even try a second one. I finally understood why.

By mid-December the akathisia was so disruptive to my life that my psychiatrist increased the daily dose of Seroquel and stopped Latuda.  The akathisia symptoms began to fade by mid-January, 2019. But my relief was overshadowed by my tireless depression, irritability and anxiety.

Enter Lamactil my knight in anticonvulsant armour. Like other drugs in this class, it may not protect against mania in the future, but according to my psychiatrist there are little to no side effects.

Lamictal was introduced gradually increasing the dose over a period of eight weeks. This is called titration. It takes so long to titrate because a serious and potentially deadly skin rash can occur, if the dose is increased too quickly.

Each week I’d take a higher dose than the last, praying to the rash gods to have mercy on me. And each week passed without event. Eight weeks came and went and the heavy fear of side effects began to lift. The weight of depression began to get lighter, the anxiety dampened, and normalcy crept in.

The medication roller-coaster was over. The new cocktail of Lamictal and Seroquel set me on the right track. This began my next journey of rounding up my emotions like a dog herding sheep. My energy returned, as did my drive to get things done. I’ve reconnected with friends and drink little to no booze.

Am I now feeling perfect? Absolutely not. I have days that I feel great but I also have days that I lose control. I need to force myself to spend time with those I love. I try to find the desire to have a clean apartment, and put the effort into keeping it clean. I struggle with the drive to focus on tasks and goals. But for the first time in 20 years, I feel like I’m in better control.

I have a new appreciation for how strong and intense psychiatric medications are. It’s no wonder it is hard for some people to stick to a medication as some side effects are worse than disorder. I’m proud I didn’t quit. But sometimes I wish I started earlier. I can’t help but wonder if I sought help for my first episode of depression those 20 years ago, what would my life be like today?

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