Life and Lims

Having a mental-health concern (that seems most likely now to be a bipolar disorder) for the past 25 years or so has naturally led to my being on various medications to try to improve my quality of life. I’ve already discussed a bit how it’s been a challenge to figure out exactly what I’ve been up against over the years (just some depression? anxiety? postpartum depression or PMS? bipolar disorder? nothing at all?), so I’ll try to go back and address what kinds of medications my doctors and I have tried to use to help me feel a bit more “normal,” or, more accurately, just better able to cope with the usual stresses and strains of life.

The first I ever took some kind of an antidepressant was toward the end of my LDS mission when I was feeling serious stress. The resident older missionary/retired doctor prescribed me a medication that would supposedly help with that. At this point, I honestly don’t remember what it was he gave me. What I do remember is that I was in pretty bad emotional shape and just going about my regular busy schedule just with a new medication didn’t help me feel any better. Besides, it usually takes a few weeks for those kinds of medications to even start making a difference, and in the meantime, I just kept feeling stressed — and guilty or bad about being stressed while I was supposed to be happy and spiritual and serving God and my fellow beings. It just wasn’t a good recipe for success as a missionary or a happy human being. So I ended up having to leave the mission behind and go home to seek help in a different environment (already talked about how that went).

I was next put on lithium when hospital doctors decided I was bipolar. I took that for a bit less than a year, I think. I felt better as time went on, mostly, but I also went back to college, where I felt more at ease and myself and had my friends around me. I am sure that the medicine must have helped though, looking back, because otherwise I probably still would have been seriously depressed/angry/stressed. But the change of environment did contribute, and after a time, I just felt that 1) the diagnosis of bipolar disorder couldn’t really fit me because I didn’t fit the “classic” signs of the “full-fledged” disorder and 2) lithium is a serious drug to be on: it can potentially damage the liver. I was having my blood tested every few months to make sure my liver was fine, but it was still a real concern. So I went off the lithium. During all this I was seeing a counselor at school, so I didn’t do all this just on my own without any professional support, but I don’t know if I had a psychiatrist on my “team” at that time.

After I married and moved to California with my husband, I know I ended up seeing a psychiatrist regularly, but I cannot remember if she had me on any medication. I know I didn’t go back on lithium. She might have put me on some kind of antidepressant, if anything, but I don’t remember for sure, and I have no idea what it was if I did take something. I do know that the first year of my marriage was very rough for me emotionally, and I prefer not to think about the way I acted. It’s too embarrassing. Luckily, my husband stuck it out with me. I also know that I was on hormonal birth control pills for the first two years of our marriage, and I am convinced that fiddling with the sensitive balance of my hormones was not a good thing for me emotionally.

I know that there were months and years I didn’t take any kind of psychiatric medicine, and there were other months and years that I did. It was always some kind of antidepressant. I took Zoloft and Wellbutrin at a few different times off and on after and between pregnancies. I took them together for a year or so, mainly because Zoloft did take away my sexual response. That’s something that’s a warning when you take that and various other medications, such as Prozac, and it’s definitely true for me. It can seem like a small price to pay, but it’s actually a pretty big sacrifice when it comes to a full intimate life with your spouse, so it bothered me greatly. Taking the Wellbutrin with the Zoloft took that side effect away.

After probably my third pregnancy, my gynecologist prescribed me a new medication, Lexapro. He said it worked well and had no significant (definitely not sexual) known side effects. I was eager to sign up. The morning after I first started taking it, I got out of bed in the morning to use the bathroom and then ended up passing out on my way back to bed. I was so scared about the weird feeling I had during that few moments that I told my husband to call 911. The paramedics came out and pronounced me fine. They said I’d most likely rubbed the back of my neck or something and had some kind of vagal episode. OK. Fine. Unfortunately, over the next 5 or 6 days that I took the Lexapro, I still felt weirdly faint and out-of-body-ish, and I figured the only thing that had changed in my life was that new medication. I visited with my general doctor, who told me that was ridiculous. But I decided it was the cause, and I stopped that Lexapro. I instantly felt better, well, fainting-wise. (The lesson here: even if your doctor says you’re being ridiculous, you still should trust your instincts.) So I went back to Zoloft or something similar, I think.

I started going to a psychiatrist again, which I hadn’t done for quite some time, just getting antidepressants from my gynecologists or general physicians, although I had still gone to see counselors for talk therapy more regularly. The psychiatrist I saw at that point, probably in 2007 or so, put me on Effexor eventually, which worked well for me for a while. He did suggest I might be experiencing bipolar disorder and might benefit not from lithium, but Lamictal (lamotrigine). He even gave me a sample pack. Even though I did consider that option, I told him that since I was feeling pretty good taking the Effexor, it seemed silly to stop taking something that was working just to try something else. He thought that was reasonable and kept me on the Effexor.

Then in 2008, my family and I moved to California from a long stint in Alabama, and life became unbelievably stressful. I’d also been taking the Effexor for probably a year or maybe a little less. At any rate, I’d probably only done well on an antidepressant for a year or so at any time I’d taken one, either because after a while, my life had settled down and I’d gone off a medication and been fine, or the medication had seemed to stop working. In this case, I just kept taking the Effexor, but my new general physician upped my dose. Shortly before another momentous, life-changing event for me, the death of my beloved dad, I started trolling the Internet and found the site I’ve mentioned already by Dr. Jim Phelps, which made me start to seriously consider the possibility that I really did have a bipolar disorder. But this psychiatrist was making the point that there was a wide spectrum of bipolar disorders, not just the “biggie” in which people stay up without sleep for a few days at a time, go on wild shopping sprees and spend tons of money, and do otherwise really foolish things they wouldn’t otherwise do. So I found a psychiatrist in my new town who was on my insurance list and made an appointment. He put me on Lamictal, which my previous physician had suggested a couple of years before. It did seem to slowly make a difference, and I was happy to be off the Effexor, although it did take a solid two or more months to very slowly wean off of that very addictive medication. (If I didn’t get a dose, I’d start feeling kind of headachy and light-headed, in a distinctively Effexor-less way.)

So I think the Lamictal gave me some relief and some hope that I was on the right track, but a couple of months into that, my dad died and sent me spinning. My psychiatrist asked me at the first appointment after Dad’s death (merely two or three weeks afterward, mind you), “So, how are you feeling?” Uh. BAD. My dad died. I’m miserable. Hard to say how the medication is working. I’d feel rotten no matter what. And that’s how it went.

A few months after that, I mentioned to some people in my church congregation that I was struggling with mental illness, and a few recommended I try a different option, a natural formulation called EMPower that was sold by a company called Truehope. The company says that the formulation contains micronutrients that are found to correct the imbalances found in those with bipolar disorder and other mental issues. I have always felt that ideally, it would be nicest to treat the actual cause of a problem rather than just the symptoms, if at all possible. This sounded like a very reasonable option, and Truehope has actually been doing scientific studies showing the benefits of EMPower.

I felt that I needed to at least give this option a shot. If I didn’t, I would never know if it could have helped me or not. So I went in to my psychiatrist, who naturally told me he didn’t agree with my decision and that he couldn’t continue to see me if I went off my prescription and took EMPower instead. I knew he’d say that, and I was ready to say, “OK. I won’t be back.” He said he knew I’d be back in a few months in even worse condition.

I tried the supplement, which is actually pretty expensive (probably about $100 a month, and not covered by insurance, of course), for about six months. I felt at first it really did help, but after a few months, I was just not feeling good enough. I tried a few adjustments and options after some phone calls with the company’s support techs, but I finally had to make the decision to end my own personal “drug trial.” I am sure that the supplement truly does help lots of people, but as with anything, nothing helps everyone. I did struggle, however, with what to do next. I firmly did not want to go back to my previous psychiatrist. He was too abrasive, and I felt I couldn’t work comfortably with him to find the best options to treat me. I finally decided to go see a nurse practitioner working in psychiatry 45 minutes away from my town because my therapist had heard good things about her from several other clients. I felt that it was going to be best for my mental health process to work with a psychiatrist who I felt comfortable with, that we were really a team, that she would be supportive. So I made the appointment. This new person, who I still see almost 2 years later, turned out to be a really good fit personality-wise, which I think makes a big difference in getting the best care possible. The only drawback is that my insurance doesn’t cover her, so I have had to pay entirely out of pocket. Luckily, I have had the spare funds to be able to pay for the visits, and it has been a good choice for me.

I’ll just call my nurse practitioner by her first name for ease of writing. Susan really went into a lot of detail with me, talking to me about the options and what she thought might work to help me, even explaining why she felt that way. I personally have really liked her approach. I like to feel that we’re on the same page, and knowing her reasoning helps me to feel more confident that is happening. We tried probably four or five different medications over the course of probably four to six months, during which time I’d go back every month to see her and check in. We tried Abilify, Prozac, and maybe Celexa. I can’t remember exactly. I did notice Prozac didn’t make me feel any better, and it just made me feel completely dead sexually, which was super-frustrating for me. So that was a no-go. I also know the Abilify didn’t do it on its own, and it actually made me feel, rather than “more normal” or “more like myself,” just kind of numb emotionally. I wasn’t stressed, kind of, but I was just dead. I didn’t feel anything. I felt like a zombie. I absolutely did not like that. She ended up adding in Cymbalta, which felt pretty helpful. Eventually, we took out the Abilify to see if that would help me feel less numb. And it did work. The Cymbalta, at the time, on its own, was a good fit for me. I’ve now been on that for perhaps 18 months.

Unfortunately, I’m afraid that now we’re getting to a point we need to tweak again. I’ve been on just antidepressants before, and I’ve either just gone off them or they’ve stopped working, and I fear this is happening now. I’m just feeling unhinged. The stresses and huge demands on my time are taking a huge toll on me, and I’m not proving up to the challenge of dealing with them in an appropriate manner. I’m coming up in a few weeks on another check-in with Susan, and I think this time we’ll have to address now how to change my dose or try something else. It’s been nice, though, for the past year, feeling pretty good and “myself.” Descending back into my “crash” mode is a scary and upsetting thing, for me and my family, and it’s nerve-wracking for me to ponder how much trial-and-error it’s going to take to get me back to happy. Will it take a couple different medications again and weird feelings of numbness or just not-effectiveness (so I’ll just feel unable to cope for a few more months? Yikes!)? My main fear is looking ahead at a few months of not being myself, far from it, especially with summer months coming on and my kids being out of school and all the stresses that places on me every summer. It scares me.

So that’s where I am, medication-wise. I’ve been a bit of a guinea pig for the past 20 years. It’s difficult because treating any kind of illness can be tricky and require some finesse. The basic stuff is kind of straightforward (infection? take an antibiotic; cold? take some antihistamines and Sudafed and wait it out), but other health issues take some trial and error. Then when it’s mental health, which is still a kind of slippery creature in the early 21st century, and every person’s needs and body chemistry is unique, it’s a science that’s more art than anything else. Being the doctor is probably a challenge, but being the patient is truly difficult. Being that guinea pig, the one on different kinds of medicines, is tricky and frustrating as all get-out. I’ve said for ages I wish there were a control group for me. But there isn’t. Good science requires a control group and an experimental group, and in this case, giving just me a medication and seeing what happens isn’t truly good science. And the onus is still on me as the patient to make the judgment calls, to figure out what’s changed, what to tell my health-care provider, about what might be significant. Do I feel better taking Lamictal even though my dad just died? Can I possibly separate out the effects of that from my normal stress reactions? Can I say I feel better on something even though a bunch of stuff has been happening in my life? If I could put myself in a quiet room without any interference from outside sources, I could judge better. But that’s never possible. (And if I could be by myself in a quiet place — resort, maybe? that would be amazing — I may very well be able to get to feeling better without the medication. Maybe. At least I wouldn’t be bothering anyone else.)

This post is incredibly long; perhaps I should have separated it into a few parts. But it’s the best answer to those who would like to know what my experience is with medications. I hope it might be of some use to those of you who struggle with similar problems and need to figure out how to look at your own situations with more clarity. Perhaps it will just make some of you more sympathetic with those in your lives who have challenges similar to mine. Or maybe those who know me but don’t know all these details about me will feel more empathetic with me. Either way, I hope this is of use to someone out there. This is an ongoing story, so I will need to update as the next few months come along and I visit my nurse again.

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