Images from rxlist.com & drugs.com

Here’s a list of the side effects I’ve experienced recently taking Lamictal and Abilify (I can’t attribute any side effect to a specific drug since I am taking both):

1. Somnolence (I am sleepy within minutes after taking the drugs.)

2. Dizziness/vertigo

3. Tremors (At night, I think I’m having convulsions but my husband says I don’t move.)

4. Delusions (I think I’m dying before I go to sleep.)

5. Disciplined sleep regimen (I wake up for the day when my alarm goes off. That’s consistently been 5:20 in the morning.)

6. Poor balance (This may be related to the dizziness and vertigo.)

I’ll add more to this list as I experience any additional side effects.

Images from rxlist.com & drugs.com

After 2 years of not being on medication, I am back to a daily regimen of lamotrigine (Lamictal) and aripiprazole (Abilify) with lorazepam (Ativan) as needed.

Many of you may know, or may not know, what I decided to taper off of medication so that I could get pregnant. Well, that hasn’t happened. And my thoughts got to a point where it became life and death again. I didn’t want to go back to the psych hospital so I asked my psychiatrist for help.

My psychiatrist (God bless him) is a very conservative psychiatrist. He was the one who helped me off of medication 2 years ago, and he’s the one titrating my dosages up now. Lamotrigine is for long-term maintenance of the bipolar disorder, aripiprazole is for short-term maintenance of bipolar disorder and SAD (seasonal affective disorder), and lorazepam assists with severe anxiety as needed. I started taking the medication four weeks ago, and I’m only on 50 mg of lamotrigine and 5 mg of Abilify. There will be no increase on Abilify and I titrate up on lamotrigine every 2 weeks. My next big jump is 100 mg.

My psychiatrist expects me to come off of aripiprazole within the next few months (hopefully by December). If not, I will have to get regular blood sugar and cholesterol tests performed. He will adjust all medications as necessary in the event that I am pregnant. He’s a great psychiatrist; he’s willing to work with me based on my situation rather than him throwing drugs at me. He allows me to have complete control over my treatment regimen, which is something I like and respect.

In the past, I may have come off as anti-medication, but really, I’m not. I advocate for use of medication in a necessary, responsible manner. In 2010, 253 million prescriptions were written for antidepressants.¹ (Keep in mind that the U.S. is estimated to have 307 million people in the country.² That’s about 82.4% of the population taking antidepressants.) This is not responsible; this is too much. In the comments, people have rightly corrected me in the assumption that 1 person can get multiple prescriptions in a year; I failed to remember that.

Let’s assume a person is on 1 antidepressant (the majority of people take 1). Beginning in January, that person gets 5 refills for 30 days. By May, the person will need another 5 refills. Then another prescription is dispensed in October. That’s 3 prescriptions per person. Of course, this can vary depending on how often the doctor will see a patient so let’s generalize and say 5 prescriptions per person per year. My calculations for prescriptions per American mean that nearly 20 percent (about 17%) of the population is on antidepressants. Sure, it’s not my original ridiculous number of 82.4%, but I still think this is pretty high. (By the way, feel free to correct my stats in the comments if necessary; I don’t claim to be a math wizard.)

While I am not on an antidepressant, I am one of the millions of Americans who is on medication for mental illness. For 2 years, honestly, I’d forgotten I had anything relating to mental illness. It was nice to wake up and be myself without thinking about me plus bipolar disorder. Every morning and every evening, it’s now me plus bipolar disorder plus SAD plus anxiety. These are all real symptoms that need to be managed. I don’t want to be dependent on this medication forever, but I may have to. If it helps me manage my suicidal thoughts and function with people in life, then it’s worth it.

Your turn: What do you think about taking psychotropic medication? Do the symptoms outweigh the risks for you? What’s been your experience in taking (or not taking) psych meds?

—

Notes:

1. Shirley S. Wang, “Antidepressants Given More Widely,” The Wall Street Journal. Published on August 4, 2011. Available at: http://online.wsj.com/article/SB10001424053111903885604576486294087849246.html. Accessed October 20, 2011.
2. Google Public Data Explorer. Population in the U.S. Last updated: July 28, 2011. Available at: http://www.google.com/publicdata/explore?ds=kf7tgg1uo9ude_&met_y=population&tdim=true&dl=en&hl=en&q=us+population. Accessed October 20, 2011.

I don’t know what to do. Anyone have any advice to offer?

Image from people.com

Catherine Zeta-Jones has bravely put her face on the cover People magazine—and on the face of bipolar disorder. And in a less publicized interview, 18-year-old Demi Lovato of teen Disney fame admitted last month to People that she too also suffers from bipolar disorder.

“This is a disorder that affects millions of people and I am one of them,” the [Zeta-Jones], 41, tells PEOPLE in an exclusive statement in this week’s cover story. “If my revelation of having bipolar II has encouraged one person to seek help, then it is worth it. There is no need to suffer silently and there is no shame in seeking help.”

Last month, Lovato said:

“I never found out until I went into treatment that I was bipolar. Looking back it makes sense,” she says of her diagnosis. “There were times when I was so manic, I was writing seven songs in one night and I’d be up until 5:30 in the morning.”

I’ve said before that I’m not a fan of mental illness fads, but bipolar disorder has such a stigma attached to it that celebrities who seriously suffer from the disorder have a chance to put a face on and say “There’s no shame in getting help.” And while psychotropic drugs certainly aren’t a cure-all in conjunction with talk and behavioral therapy, bipolar disorder can be managed—not just for these celebs but also for anyone who suffers from the disorder.

Image from people.com

Of all the celebrities I would have pegged with some kind of mental health disorder, Ms. Zeta-Jones would have never made the list. After supporting her husband Michael Douglas through his cancer treatment, she remained quiet about herself only outspoken on issues pertaining to how upbeat and positive the couple was on Douglas’s treatment.

But clearly, being a bedrock for her husband has taken its toll on her. Last week, she checked into a mental health facility seeking treatment for her bipolar II disorder. Bipolar II is characterized by frequent depressive episodes rather than a constant swing of manic-depressive ones. While only Ms. Zeta-Jones knows what’s been going on inside her mind and her heart, I can only imagine that she’s been suffering with some depression for a while but quietly put it aside as her husband struggled to become healthy again.

In the past, I’ve used the Celebrity Sensitivity feature of this blog to mock celebrities who seem to be diagnosed with nearly any mental illness fad that goes around (normally, depression), but this time my heart goes out to Ms. Zeta-Jones who decided to seek treatment for herself instead of putting on a face like everything’s okay and toughing it out.

Image from zazzle.com

Although I’m not a fan of the Dexter books or TV series, I’ve been introduced to both by way of my husband who enjoys both forms of Dexter media.

The other day I flipped through Jeff Lindsay’s latest, Dexter Is Delicious, and read a little bit about the part of Dexter that he calls his “Dark Passenger,” the voice inside of him that compels him to kill. (But he justifies this by killing murderers. An interesting twist on the anti-hero.)

I ruminated on this as I’ve been dealing with a lot of suicidal thoughts lately. And really, there’s nothing wrong in my life that would cause these suicidal thoughts to arise. It’s just something in me gone haywire. It’s like a part of me that’s not really a part of me that I can kind of talk back to. It sounds otherworldly and crazy.

It is.

So I’ve taken to calling the suicidal voice (unlike Dexter’s homicidal one) in my head the “Dark Passenger.” My husband kind of likes this too as it identifies something that’s not really me although it’s a part of me.

The Dark Passenger is pretty random these days. Even if I have a slight mood crash, he’ll—because my sinister voice is clearly not a seductive she, maybe androgynous—tell me that life is not worth living and to go kill myself.

Me: What?
Dark Passenger: Go kill yourself. Life isn’t worth living anyway. You’re a total failure and you know you can’t do anything right.
Me: Um, why are you bugging me? I’m not even depressed right now.
Dark Passenger: [silence]

Yeah, that’s pretty much how our conversations go. It probably sounds a bit schizophrenic or something but that’s basically my stupid battle to stay alive. You can probably imagine how terrible our conversations are when I am depressed.

My Dark Passenger’s a bit starved, you see, because I haven’t tried to kill myself in a while and he’s getting antsy. I was last hospitalized for a suicide attempt in 2006 and even though I’ve had a few half-hearted attempts since or serious thoughts about an attempt, I haven’t had a serious attempt that has required me to be locked away for a good bit of time. I still get freaked out about my near-sexual assault encounter and that’s done a good job of keeping me in check for now.

So the Dark Passenger tries to get me whenever he thinks he’s got an opening:

No one signed up for your class. You’re a loser. Go kill yourself.

She never called you back. See? No one likes you. Go kill yourself.

You can’t get pregnant or do anything right. You’re not cut out to be a mother. In fact, you weren’t meant to be one because you need to go kill yourself.

And on and on and on. It’s easy to tell him to shut up when I’m not deeply depressed. Not so much otherwise.

Maybe there’s something to that “Get behind me, Satan” stuff after all. D. Martyn Lloyd-Jones, a famous British preacher, once suggested in his book Spiritual Depression to “talk back” to one’s negative voices. While it doesn’t work in the most severe of cases for me, it works. . . for the most part.

In 2008, bipolar disorder became a list of covered psychiatric conditions under the American Disabilities Act (ADA). While I support the move, I’m somewhat guarded about it since there are a variety of symptoms within bipolar disorder that can make it difficult for a person to perform his or her job. From PsychCentral’s post about it in September 2010:

For ADA purposes, major life activities that may be limited by a mental health disorder could include learning, thinking, concentrating, interacting with others, caring for oneself, speaking, or performing manual tasks. Sleep also may be limited in such a way that daily activities are impaired.

Someone with bipolar disorder may temporarily experience “limits” to handling life activities. A deep bout of depression or insomnia may create a need for time off or for flexible hours. An individual may need time off for doctor appointments. In the daily work environment he or she may need a quieter work area to decrease stress and enhance concentration or more frequent breaks to take a walk or do a relaxation exercise. He or she may need office supplies to help them organize and focus more effectively.

I’ve experienced all of these issues at one point or another (sleep issues have been the most frequent and debilitating) in the past and I completely understand how it can affect someone’s ability to work. However I worry that someone might use this to their advantage to cover bad behavior rather than someone who legitimately needs this protection. But alas, abuses to systems exist everywhere.

This coverage prompts me to ask the question: is bipolar disorder (and depression as well) a legitimate disability?

I’m also trying to get pregnant.

I haven’t wanted to discuss this particular phase of my life as I think it’s a very personal and private time. However, the emotional and mental toll that TTC (trying to conceive) brings upon someone who struggles with mental illness, I think, is worth discussion.

I wrongly assumed that when I decided that I wanted to have a child, I’d automatically be able to get pregnant. (Bristol Palin had no problem, right?) Several cycles later, I find myself still childless and even more desperately yearning for a child than the month before.

The mental anguish of TTC month after month is tough for any normal woman. During this phase of life, women may experience the following feelings:

• Anger
• Depression
• Anxiety
• Low self-esteem
• Social isolation
• Sexual dysfunction
• Marital problems

In a woman who suffers from depression, bipolar disorder, or any other mental illness, those feelings can become so intensely extreme that they can be debilitating.

I can’t even begin to explain the psychology behind the agony a women endures when she desperately hopes for a child, only to be disappointed by a negative pregnancy test or the monthly visitation from a visitor commonly known as Aunt Flo. Month after month and year after year, the pendulum of emotions range from anger to despair. How is it possible to want and love someone so much whom you’ve never met?

For me, I’ve found that I am relatively sane and able to go on with life for about a week after trying. When I am a day or two away from my expected period, I am thrown into such emotional turmoil that I am nearly inconsolable. Part of it has to do with the sadness that accompanies my body preparing itself for the beginning of a new cycle; the other part of it is the emotional roller coaster that comes along with PMS (premenstrual syndrome). Throw in a dash of bipolar disorder and there’s no limit to how despondent I can be. I can only imagine the same would be true for women who suffer from other mental illnesses.

During those times, I’ve tried turning my eyes toward God and attempting to put my faith in His wisdom for my life, but I feel so isolated and so alone that I wonder if even God could comfort me. The pain of hoping for a child each month then discovering that it is not to be brings a sense of abandonment (for some reason). Negative thoughts creep into your mind at a furtive pace:

• I’m not meant to be a mother because I’m already suffering from a mental illness and God is doing any kids I’d have a favor by not bringing them into this world through me.
• I’d be a terrible mother anyway.
• What is wrong with my body? Why can’t I conceive?
• There’s no point in me living if I can’t have a child. I want a child of my own so desperately that I just don’t want to live anymore if I can’t have one.

Each month, a woman trying to conceive goes through the five stages of grief:

1. Denial (The pregnancy test must be wrong; I’m pregnant for sure. Maybe my hormones haven’t been detected yet.)
2. Anger (Why is this happening to me? What’s wrong with me?)
3. Bargaining (I’ll do anything be pregnant. Please, just give me a baby.)
4. Depression (I’ll never get pregnant. What’s the point? I’ll be a terrible mother anyway.)
5. Acceptance (I’m not pregnant. [Some women can also say: But at least we can try again in the next cycle.])

I usually go through all that in the course of, oh, about 2 days.

I haven’t been trying for an extremely long period of time so I’m not classified as infertile but the internal and external pressure of trying to conceive can be stressful nonetheless:

• Family members ask when a little one will arrive in your family
• Friends and family members will have conceived (and even given birth) to a child within the time you’ve been attempting to conceive
• Well-meaning people offer advice to simply “relax” and go on vacation to get pregnant
• Pregnant women you know will complain about all the awful symptoms of pregnancy
• Mothers you know will complain about all the downsides of parenting and rarely offer the upsides

I haven’t fully figured out how to deal with the uncomfortable situations I find myself in with others or the drained energy that comes from learning of a barren womb. This site provides coping techniques for normal women dealing with infertility, but I want to go a step farther in specifically addressing women TTC who suffer with some kind of mental issue:

• Talk to a trusted doctor or counselor. Determine this is the path that you want to be on and discuss how to develop strategies in the face of another disappointing month.
• Determine whether you need to take medication (if you’re not already on it). I tapered off of my mood stabilizer in the hopes of being able to have a natural birth and breastfeed. I’m altering those dreams. It’s not the end of the world if I have to have a baby in the hospital and a child won’t die if I feed it formula. (Although I’ll probably catch flak in the Christian community because what self-respecting mother doesn’t breastfeed?! [sarcasm])
• Determine whether you need an adjustment in medication if you are taking something. Is the medication you are on relatively safe for pregnancy? Will you need to switch? Is the medication you’re currently on affecting your ability to adequately deal with the emotional pendulum that accompanies TTC?
• Consider using natural mood-boosting remedies to bolster your mood. I know it’s cliche to mention this, but for some women suffering from mental illness, natural remedies actually do help. (For some women, natural remedies have little to no effect.) Here are a few to try:

• • Take at least 1000 mg of Omega-3 fatty acids daily. BEWARE: 1200 mg of fish oil does not equal 1200 mg of Omega-3s! I take 900 mg capsules of fish oil that only contain 450 mg of Omega-3s each. I need to take at least 3 capsules to get more than 1000 mg of Omega-3s. You can also get the weekly required amount of Omega-3s by eating fish twice a week. (Science Daily)
  • Take daily multivitamins with at least 400 mcg of folic acid. Folic acid helps lower the risk of birth defects in a baby. For me, I need the iron supplement to help me fight fatigue as I don’t eat many foods rich in iron.
  • Exercise regularly. I’ve been exercising about 3-4 times a week for about 30 minutes. Exercising temporarily boosts my mood although that’s only been a recent occurrence (within the past year).
  • Try to steer clear of mood-altering substances. The depression that accompanies not having a child can drive a woman to smoke, drink too much alcohol, or engage in the use of illegal drugs. (I’m guilty of having a bit too much wine.) Although we all know to avoid this stuff when TTC, it’s sometimes hard to resist. But try.

I hope this post can be of some help to women who are trying to conceive but also suffer from mental illness. We may be a small minority but we’re not alone. Feel to offer feedback on this post by leaving a comment.