Thoughts on Bipolar Overawareness Week: Part II

Here are some things that have occurred in my life:

  • racing thoughts
  • spending sprees when I have no money
  • cleaning at odd hours of the night
  • thinking that I’m the most amazing job interviewer ever
  • worrying that people are watching me through video cameras or the wall in public bathroom stalls
  • afraid that a video camera exists in our bedroom (I know it doesn’t. I think?)
  • talking to "friends" who don’t really exist
  • disobeyed parents
  • talked back to authority
  • suicide attempts
  • rage/anger/hostility/irritability
  • temper tantrums
  • violent outbursts
  • socially awkward
  • extreme mood swings (happy to sad or angry in the same day)
  • doing things and barely remembering them
  • memory loss/forgetfulness
  • chronic fatigue
  • indecisiveness
  • no interest in sleep
  • inability to focus on one thing for an extended period of time/lack of concentration
  • anxious about being around people I don’t know/don’t like
  • anxious to go out and spend time with friends and/or family
  • impulsiveness
  • overeating
  • persistent, negative thoughts

All right. So those are some things that have occurred over the course of my life. Let’s see what I diagnoses I can pigeonhole myself into.

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The "Black Dog," Part III

By the end of March, we decided to get engaged and work out our differences. (I’d move to Kentucky and he’d be open to not having biological kids.) In early July, I quit Lexapro cold turkey. (This, folks, is a NO-NO.) Two weeks later, I had a relapse and attempted to commit suicide. Bob freaked out and called the cops and I nearly lost my job at a prestigious magazine. It wasn’t Bob’s fault; it was mine for quitting a med cold turkey and it was Dr. X’s for not warning me about the potential for suicide attempts on the drug. Perhaps she didn’t know. After all, she kept doling out Lexapro samples to me via the drug rep. When I told her in August that Lexapro wasn’t working, she became skeptical, assumed that I was still being noncompliant and wrote out a prescription for Zoloft. By that point, I was tired of meds. I’d gained 40-50 lbs between Paxil and Lexapro (after being skinny all my life) and still had a difficult time functioning normally. I never filled my prescription.

I moved to Kentucky in September and started a new job in October. After things became a little hectic and overwhelming at work in December, I became suicidal once again. I never saw Bob during the day (I worked second shift into third shift sometimes) so he was able to be depressed during the night and hide it apart from me since I rarely saw him. Bob, fearful of a failing marriage and I’d make good on my promise to kill myself, made the decision for us to move back to his hometown in Pennsylvania in April 2006.

As of January 2006, I knew I needed to be hospitalized and talked about it frequently. However, I felt like I couldn’t: "My job needs me," I said. "We’re understaffed. My job needs me." Even the anxiety of handing in my resignation at a job I hadn’t been employed at for a year gripped me.

We began our job search in the metro Philly area in April and both landed jobs in May. He in the suburbs; I in Philadelphia. My suicidal attempts and thoughts remained with me, but began to increase in August. My sick days became frequent. After a honeymoon at the end of August, I came back in September to a hostile co-worker and a micromanaging, picky boss. Those factors – in addition to whatever I was already dealing with – contributed to taking a disability leave from my job and admitting myself to a psych hospital. I’d been unwilling to do it because I was so busy, but if not, my husband would have been forced to do it for me.

I stayed in the hospital for 7-8 days. The doctor who initially admitted me asked me what meds I’d been on. I said Lexapro and Paxil. I mentioned I didn’t like them. He suggested that I try Celexa in the meantime and that it wasn’t the same as those two. Before I began this blog, I had no idea that Lexapro (escitalopram) and Celexa (citalopram) are virtually the same thing. I passed on Celexa at med times, knowing that my case doctor would be switching me to something different. My case doctor, Dr. S, recommended Effexor XR after I told him that I’d had trouble with Lexapro and Paxil. He said, "Well, it’s an SNRI and functions differently than an SSRI. Let’s try you on that. We’ll start you off at 37.5 mg and get you up to 150 mg by the time you leave."

On the first day of Effexor, I developed severe somnolence that lasted an hour. Later that day and the next three days, I developed severe dry mouth. I’d never known what dry mouth was until then. So I chugged several Snapple Iced Teas a day since water wasn’t available through their vending machines. (Weird, I know.) When I began at my intensive outpatient treatment afterward, a nurse told me that drinking too much sugar can cause the liver to overproduce sugar – if I remember correctly – which can lead to diabetes. *sigh*

Because of a (somewhat) sexual assault incident at the hospital, my release was hastened and I left at 75 mg of Effexor. My psychiatrist at the outpatient clinic titrated me up to 150 mg, which according to him, "is standard. Some patients do better at 300 mg." (!) By the time my outpatient treatment was over, I was steady at 150 mg of Effexor.

In the meantime, my husband was overtaken by all the events that had been occuring since August. (You’d be freaked out too if you woke up to see your spouse trying to hang him/herself.)

In November, he finally admitted to me that he struggle with depression. He began crying all the time over nearly everything. As a computer programmer for seven years, he felt inadequate and insecure at his new job. He cried over my depression. He cried about worsening my depression with his depression. He became anxious over everything. He couldn’t sleep in the event that he’d wake up to see another suicide attempt. He became wracked with anxiety. After much provoking and nagging, he finally agreed to seek treatment in the evening at the outpatient clinic I’d been to. He found it somewhat helpful but admitted that it was difficult to act on what he’d learned.

November threw another curveball at us when my outpatient psychiatrist diagnosed me with bipolar disorder. That finally explained my hostile, irritable, and angry episodes (which normally occurred at night) in addition to my depression. Now, Bob became anxious over the next manic episode that might occur.

Just as he had involved my mother of my situation, I sat down with his parents and spoke with them about Bob’s. His parents seemed taken aback. The quiet, shy kid had all these problems that they’d never known about? His parents and I thought that Bob was freaking out over me and the recent events. Little did we all know that it was simply a trigger. Since I was around Bob all the time now, he wasn’t able to hide it from me any longer.

Despite weekly counseling that we began in August, he still suffers from extreme anxiety. He still suffers from depression with passing suicidal thoughts. He still cries and gets angry over, well, insignificant things. But he’s been brave to admit that he struggles with depression. He’s taken a leap of faith to talk to his parents, his brother, and me about what he deals with and some of what he’s been thinking. Bob has a long way to go, but he’s finally taken the steps forward to recovery.

Pristiq's under-the-radar clinical trials

News stories on Wyeth’s Pristiq, Effexor’s “knockoff”, have focused on the drug’s uses that are pending FDA-approval: vasomotor symptoms accompanying menopause (see hot flashes) and depression. (“Knockoff” term courtesy of CLPsych.) The major media has failed to pick up on Wyeth’s Phase III clinical trials to use Pristiq for fibromyalgia and neuropathic pain (injured tissue or damaged nerve fibers) in diabetics. A search for Pristiq on Wyeth’s Web site yields no results. Desvenlafaxine yields two very meager results.

In related matters, bifeprunox is pending FDA-approval for the use of schizophrenia and is still in Phase III for use of bipolar disorder. They are also in Phase III of testing Lybrex (levonorgestrel) for use for Premenstrual Dysmorphic Disorder in addition to the drug functioning as an oral contraceptive. (I’ll be honest; I had NO clue that diagnosis existed.) In any event, I’ve been misdiagnosed because according to the symptoms, I qualify. I think I also qualify for OOPS – Overdiagnosed and Overmedicated Patient Syndrome.

I’d like expound on Wyeth’s Learn and Confirm phase that’s supposed to replace Phase I and II of clinical trials. It sounds like a speedier way to just get drugs to Phase III of clin. trials, but it’s late and I’m working on something else, so I’ll save that for another day.

Also something to tackle in the future: All these interesting clinical trial results for Effexor XR involving depression and GAD. We’ll see…

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Mood: 6.5