Mental Health Awareness Month: Psychotropics

 

Aside from being an objectively cool band name for people with mental illnesses, psychotropics is an umbrella term for the classes of drugs used to treat mental disorders and control moods, behaviors, thoughts or perceptions.

There are five categories (and multiple subcategories) of psychotropic medications: antidepressants, anti-anxiety medications, stimulants, antipsychotics and mood stabilizers. And like many of my fellow mental-illness travelers, I’ve tried damn near all of them.

Here’s a brief rundown:

ANTIDEPRESSANTS, as you might surmise, are used to treat a range of depression symptoms. They include:

• Selective serotonin reuptake inhibitors (SSRIs), which steadily increase the amount of serotonin in your brain. Serotonin is a powerful neurotransmitter that regulates things like mood, sleep, blood clotting and even bowel movements. (Aren’t you glad you know that last part?)
• Selective norepinephrine reuptake inhibitors (SNRIs), which gradually increase the amount of norepinephrine in your brain. Norepinephrine makes you feel awake and alert. After over a decade of trial and error, my doctor finally landed on the SNRI Fetzima as my magic bullet, and aside from a blackout-go-boom-get-concussion on the tile floor a few days after I started it, it’s been a complete game-changer for me.
• Bupropion, which promotes important brain activity and can be used to treat seasonal affective disorder (SAD) or to help people quit smoking.

Antidepressants come with a range of frustrating side effects, including drowsiness, insomnia (how fun to have both!), constipation (more poop stuff!), weight gain, sexual issues, tremors and dry mouth.


ANTI-ANXIETY MEDICATIONS are used to treat panic attacks, phobias, generalized anxiety, and various anxiety-related symptoms.

This class of psychotropics includes beta blockers that help treat the physical symptoms of anxiety, including increased heartbeat, nausea, sweating and trembling.

Because they typically cause drowsiness, some tranquilizers and sleep medications are also used to treat anxiety and insomnia. These tend to be prescribed for only a short time to prevent dependency.

These drugs’ side effects can include nausea, blurry vision, headaches, confusion, fatigue and graphic nightmares. And oh, have I had some doozy graphic nightmares on my find-the-right-psychotropics journey.


STIMULANTS help manage unorganized behavior by improving concentration and providing a general sense of calm. They’re often prescribed for people with attention deficit hyperactivity disorder (ADHD).

Their most notable side effects include insomnia, decreased appetite and weight loss.


ANTIPSYCHOTICS help manage psychosis, which separates people’s perceptions from reality and drowns them in delusions or hallucinations.

Antipsychotics can help people with psychosis think more clearly, feel calmer, sleep better and communicate more effectively. They’re also used to treat ADHD, depression, post-traumatic stress disorder, obsessive-compulsive disorder and eating disorders.

Their side effects are primarily drowsiness, upset stomach, increased appetite and weight gain.


MOOD STABILIZERS help regulate extreme emotions. They may rob you of feeling the extreme excitement or extreme sadness that everyone experiences—which is my case—but they help manage massive bipolar swings and extreme mood swings, which is a tradeoff I’m happy to live with.

I regularly experience all their usual side effects: drowsiness, weight gain, dizziness, tremors, blurry vision and occasional confusion. I’m especially unhappy with the weight gain, but thanks to an effective mood stabilizer (in my case, the relatively common drug Lamotrigine) I can consistently and reliably participate in everyday living. Even though I have to have a damn Santa tummy to do it.


THE SIDE EFFECTS OF THESE MEDICATIONS can be powerful and overwhelming. There’s one set of side effects that present when you’re ramping up a dosage, there’s another set of side effects that come with daily use of a drug, and there’s another (often excruciating) set of side effects that come with weaning off a drug. Which is why I’ll never understand the mindset that some people get where they decide they feel fine and they’re just gonna stop taking their meds.

Timber!

Nine years ago today—three years after leaving the hospital and just hours after taking the very first dose of yet another new bipolar med added to my ever-evolving cocktail—I stood up from a chair, walked a couple steps, blacked completely the hell out, fell Timber! onto the tile floor (which I cracked with my face because GO BIG OR GO HOME), shredded myself eyebrow-to-chin on my shattered glasses, bit most of the way through my lip, loosened some teeth, got a concussion, and woke up in my sister's car holding a huge bloody rag to my face too confused to remember that Christmas had happened (or, for just a few glorious moments, that I was even bipolar) as she rushed me to the ER, where I looked so brutally horrifying that the nurses assumed I was the victim of a violent assault and three police officers were dispatched my room to question me well before the doctor showed up to assess the damage, declare me not dead and give me double-digit stitches.

I came home covered in swelling and bruises and scabs and stitches and glue—after telling the ER doctor in my foggy haze that my modeling days were over and I didn't care if he left scars all over my face but I vaguely remember him informing me that he still had a professional obligation to do his best—and filled eyeballs-to-spine with a deep, not-for-amateurs headache that brought crippling new levels to my understanding of pain ... and yet I still found a way to take time out of my busy schedule for a quick selfie to document the occasion for future biographers. (You're welcome, posterity!)

This Timber! event was directly linked to my new drug (called Fetzima, who sounds like a possibly immodest resident of the Anatevka demimonde in Fiddler on the Roof) that, as with all psychotropics, came with an alarming list of ramp-up side effects ... including abrupt blackouts. But I knew from a decade-plus of trial-and-error experience that I needed to tough out the first three or four weeks until the side effects subsided and the drug's level (or not level) of efficacy manifested (or didn't manifest) itself.

And despite its hyperdramatic entrance into the madcap musical of my life, Fetzima more-or-less quickly proved itself to be perhaps the drug that effectively balances my serotonin and norepinephrine and keeps me (more or less) stable and engaged and functional and capable and able to go to work and do shows and take care of my parents and run races and do handyman projects (quite well, if I can toot my own horn, which I shamelessly will) and practice the piano and buy shoes and buy more shoes and here I am nine years later, scar-free (thanks, conscientiously ethical ER doctor!) (though it took a good six months for the scars to heal and the scar tissue where I bit through my lip to subside to the point that I could drink out of a straw again) and concussion-free (pro tip: you DO. NOT. EVER. want a concussion), and clearly in possession of new old-man mouth wrinkles and silver foxiness.

[Super-fun side note: Aetna, in its infinite wisdom, abruptly stopped covering my Fetzima for two years and summarily rejected all three of my doctor’s allotted appeals. Because apparently risking sending me to the psych ward for another week was far more cost-effective than covering a proven psychotropic. So my doctor hoarded samples for me in the hope that Aetna would finally get its head out of its fetz (which it eventually did) and/or Fetzima’s patent would expire, it went generic and it stopped costing $700/month out of pocket (which has yet to happen).]

Anyway, if you're inclined, raise a glass and yell Timber! in my scab-free, concussion-free, fog-free, not-functional-free honor today. I'm gonna go out and keep living. Timber!

Timber!

75 days ago, just hours into starting a new bipolar med, I stood up, blacked out, fell Timber! onto the tile floor (which I cracked with my face because GO BIG OR GO HOME), shredded my face on my shattered glasses, bit most of the way through my lip, loosened some teeth, got a concussion, landed in the ER, came home covered in stitches and glue and filled eyeballs-to-spine with a not-for-amateurs headache, and still found a way to take time out of my busy schedule to take a selfie.

Fast-forward 75 days to today, where I still have scars on my cheek and under my eyebrow and the right side of my upper lip is still so thick with scar tissue that I have a hard time drinking without drooling. And I clearly still need to get in the regular habit of shaving my neck. But I'd do it all over again instead of putting myself through the last hour I spent trying to find a way to put these two photos side by side with reasonably matching head sizes for a single before-and-after image. After googling and clicking and uploading and downloading and iPhotoing with absolutely zero success, I finally just opened the pix side by side in Finder and took a picture of my screen. I might as well have just drawn it all with ox blood and soot on a cave wall.

Ironically, that new black-out-go-boom bipolar drug seems to be the magic bullet I've been looking for since forever; after the requisite miserable ramp-up period, I've had over a month of overwhelmingly good days. Minus a few blips here or there. And that hasn't happened in probably four years. So if you're so inclined, raise a glass and yell Timber! in my scab-reduced honor today. I'm going to the gym. Because for the first month in many years, I'm able to do so. 

Timber!

In which I whine like an entitled first-world child

(Self-indulgent navel gazing ahead. Plus words. Lots and lots of words. With a tinge of judgey misanthropy. Plus some legitimate stuff so I don't come off as some asshole judgey misanthrope. If I've already bored you by this point, you're gonna be hating my by the time I get to the closing parenthesis. Assuming I ever get there. I'm clearly in a cranky mood though, so I can't help you. Or is it won't? Anyway, abandon hope all ye who read from here. You've been warned.)

• Everyone at Kohl's tonight was either moving too slowly, chatting in front of the extra-large clearance shirts so I couldn't get to them or stupidly looking in the wrong direction as they bumped their carts into me.
• Stupidly.
• Plus Kohl's didn't have anything I wanted. At least that I could get to.
• The cute guy who waited to hold the door for me at Barnes & Noble and circled the CD racks with me and ended up right in front of me at the checkout told the clerk that the CD he was buying was for his wife.
• Dinner at Cheddar's was accompanied by a full 30 minutes of bloody-murder baby screams to my right and a bellowing right-wing redneck hawking up gallons of phlegm and emitting an almost visible effluvium of cigarette stench in the booth behind me.
• I got a Facebook memory reminder this morning with my dismayed post about just having shattered my iPhone screen. Which means I've been using and squinting through and whining about my shattered screen for a whole year. The Verizon guy tonight told me I had to get the screen fixed before he could do anything related to my warranty, so I let out a long dramatic sigh and reluctantly decided to suck it up and give up my phone for 24+ hours to finally get it fixed and I drove over to the fully lit screen-fix-it store just as my phone clock ticked over to 7:01 pm. Guess why I'm telling you this. Just guess.
• Aside from a few blips, I've had at least three full weeks of good and engaged and productive and present and functional and relatively happy days. Which is an almost unprecedented record over the last 4-5 years. So the new bipolar med cocktail that initially made me black out and sent me lacerated and bloody to the ER seems to be actually working. But the uncomfortable and frustrating and embarrassing side effects have steadfastly dug in their heels, and I spent the morning wiping miles of spider webs off my face and loudly chomping on invisible gum. And trying everything in my power to sit the goddamn fuck still like a normal fucking adult.
• Plus I seem to have stopped peeing. Both in frequency and volume. Plus I just told you about my pee problems. Which just compounds the embarrassment. Nice going, me.
• Our lying, petulant, willfully ignorant man-boy of a horrifying national embarrassment of a president gave a morally and intellectually infuriating press conference packed with accusations and excuses and insults and tantrums and laughably implausible generalizations yesterday that continues to send shockwaves through the media and the educated class and the reasonable voices that he's well into his second year of attacking relentlessly with a conspicuous and alarming and desperately pre-emptive level of defensiveness. The last four weeks have made my family and my ex and many of my friends almost physically ill with worry and discouragement and deep, profound concern. And yesterday—when I heard a staunch man-boy supporter sum up the press conference with a thoughtfully nuanced "he sure told 'em"—it finally broke me too.
• I have so many shoes and shirts and shorts and pants and belts and socks and probably layers of flattened desiccated cats piled up in my bedroom that I don't even know how or where to begin sorting and inventorying and letting go of any of it. Sometimes it makes me feel all cozy when I climb into bed surrounded by jumbled mountains of all my stuff. But mostly it makes me feel paralyzed with panic and shame.
• All my real-life and Facebook crushes are pairing up and getting engaged and getting married and are mostly straight anyway. Fuck.
• When I blacked out and cracked the tile floor with my face last December, I bit most of the way through my lip. It's still swollen and hard like it's healed as scar tissue and I have a difficult time drinking through a straw or eating without getting food all over my lips.
• Hey, paired-up and engaged and married and mostly straight anyway crushes who've been bored enough to read this far! How ravishingly sexy am I right now? You should date me! It'd be fun!
• Actually, dumping all this whiny shit out of my head and posting it here after everybody's bedtime where it probably won't be seen has alleviated most of my crankiness. Thanks, Internet!
• Except I'm still furious and incredulous and devastated about the petulant, inarticulate man-boy.
• And frustrated and embarrassed by the spider webs and invisible gum and whatever fresh indignities tomorrow has in store for me.
• Plus Bitch Kitty will sleep contentedly on my clean laundry but won't exist in the same room with me unless she can draw blood or crush spirit. And sometimes it just quietly destroys a little bit of me.

Scars and haircuts

One month ago right now I'd just completed my signature black-out-and-fall-Timber!-and-crack-the-tile-floor-with-my-head-and-lacerate-my-face-with-my-shattered-glasses-and-bite-mostly-through-my-lip-and-get-a-concussion-that-hurt-like-hell trick and I was finally back awake and reasonably coherent as the emergency room doctor sewed up my face with anesthesia that totally didn't work. But I was a big boy and I whimpered only 37 times. Before I lost count.

Anyway! I sure can prattle on and on and never get to the point sometimes. OK, all the time. Like right now. I mean really. How tedious.

Anyway again! I've had stitches and protective stitches glue and scabs and oozy gross stuff all over my face and in my beard since my visit to the anesthesia-resistant emergency room sewing circle and since I looked like a moldy desiccated cat anyway I kinda stopped caring that my gooey beard was scraggling down over my neck and my hair was blossoming into a luxurious, full-bodied thneed.

But! As of this week my beard goo has finally disappeared and nearby children have stopped spraying me with Zombie-B-Gone and since it's actually been one month to the day I finally went and got a haircut and a beard trim and five new shirts at Target but don't tell my mom that last part because she keeps saying I'm finally handsome again and if she found out I'd gone recreational shopping it would totally harsh her buzz as the kids say. Or the drug addicts. Whatever.

Whew! So I finally got to the point and I feel human again and my mom says I look handsome and I'm kinda hoping when everything is totally healed I still end up with a badass scar on my cheek so when I'm in the nursing home and little schoolchildren come visit me through their scary-old-people-need-love-and-poorly-drawn-crayon-art program and they ask me about my battle scar I can regale them with the epic tale of that one time I passed out from standing up too fast to change the laundry.

Despite what your lying eyes might tell you ...

I am not an internationally famous pout model. I'm a PERSON. And I deserve to be treated as such. Except for apparently a few more weeks while what remains of my stand-up-and-black-out-and-crack-the-floor-tile-with-my-face scars continue to dig in their little scar heels and slow the healing process to a glacial pace. Fortunately after three weeks they continue to itch and sting an creep creepily and all spidery into my visual periphery. But now they're also—and I swear I'm selecting my words judiciously so I don't get all graphic and horrifying here—more stickey-outey on my face and tiny sections of them are clearly starting to follow gravity but with a stated mission to never let go—how am I doing so far?—but I still can't be a big boy and bravely pull them off like a band-aid because—and I'm sorry but there's really no delicate way to put this—my absorbable stitches haven't finished (or even started?) absorbing and the damn things are still stitched to my face. 

And you can open your eyes now; I'm done writing about gross things. I think.

So I'm trying not to be all-bipolar-all-the-time because despite my long and verbose and thoroughly documented history of being all bipolar all the time I'm actually fucking sick of it: the free-falls to despondency, the impermanent triumvirates of normalcy and clarity and energy, the endless and clearly more and more arbitrary attempts at changing meds that eventually and predictably fail one after another after another, the new wrinkle that I'm apparently apt to stand up too fast and black out and crack the tile floor with my face, and the endless worry and frustration and exacerbation I cause my family and friends as I cycle through all of the above and ultimately end up sleeping through life. So I'm actively trying not to think about it. But while we're here ... speaking of all of the above, I'm (I hope) finally emerging from a rough four days of hairpin ups and downs and canceled plans and missed uncling and a weekend where I've barely left my bed and never left the house all as a prelude to point out my soaring bedhead. Honest! I just broke my promise to myself to drastically minimize my bipolar talk with the honest intention of providing a few words of context beyond "I haven't showered all weekend" to help you laugh at my lofty locks with a more informed sense of derision. You're welcome.

And you can open your eyes now; I'm done wallowing in emotional and tonsorial self-pity. I think.

Actually, no. In the last few months, four—four!—guys I've had long-ago, too-shy-to-ever-tell-them, clearly unrequited crushes on have announced their happy gay marriages on here. I haven't seen or even thought about some of these guys in over a decade. I didn't even realize we were Facebook friends. And I'm not sure what to do with all these weird, long dormant emotions these four rapid-fire revelations have awakened. And I'm not sure why I'm being all Duckie and weighing down this already ponderous post with this information except to get it out of my head. Which I guess I've done.

And you can open your eyes now; I'm done brain-dumping all the vaguely whiny, I-don't-know-what-to-do-with-all-of-this emotional noise in my head. For realz.

So it's a relatively quiet night here at the Stigers Home for Bitchy Cats. Mom is reading, sometimes aloud to my mostly blind dad; Sibelius' watery, disciplined, asymmetrical, shamelessly triumphant Second Symphony is on repeat in the background; Dad just accidentally stepped on the cat, an incident I will be neither amused nor disquieted by; I downloaded a Gaither Vocal Band southern gospel song for my folks and now iTunes is trying to sell me all the desperate tatters of the inauguration entertainment lineup; we're all waiting for the dire-warninged but now rudely late snowpocalypse that has kept everyone pre-emptively hiding in our houses all day; and one of us is obsessively typing a seven-mile Facebook post on his shattered iPhone screen. But I won't say who.

And you can open your eyes now. Or close them with me; I'm going to bed now so I can get up at six for a much-needed ass-whupping by my trainer. And I'm not taming my hair for her.

So this happened last night

And my head and my brain are in such screaming pain right now that I feel compelled to type this very slowly on here before I attempt to escape the pain with sweet, sweet sleep. I'll give you all the blood-soaked details when I wake up and the pain subsides and my eyes uncross.

But I will tell you that one of the three cops involved was really cute.