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.

Inpatient

After a year of unemployment in Chicago where I half-assedly looked for jobs and shuffled back and forth from Cedar Rapids, I more or less officially moved home eleven years ago this month.

My bipolar disorder was escalating and I was seeing what I now understand was a hack psychiatrist (because how can you know what to look for and who’s competent when you’re new at finding mental health professionals and you’re crippled by a mental illness?) who kept prescribing medication after medication (including the anticonvulsant Depakote that I had NO business being on due to its highly problematic interactions with my Lamictal mood stabilizer) without following up or even letting me know what catastrophic side effects to look for. And my unmanaged Depakote cocktail was a living nightmare of day-long blackouts, terrifying hallucinations, and sleepwalking through what was thankfully benign but could have been fatal odd behavior.

Every psychotropic drug gives you temporary—sometimes awful—side effects as you ramp up on a new prescription and wean off of it when you find out it doesn’t work. And thanks to this doctor’s random changes of drugs and cocktails, I was in a constant state of up-and-down side effects that left me miserable and confused and unable to function in a multitude of ways.

On top of all that, I was newly single and living alone for the first time in seven years, which meant I didn’t have an extra brain in the house to remind me to take that litany of changing meds on their prescribed schedules.

So by the time I decided I was moving home, I was a mess. A catastrophic, dissociative, emotional-train-crash mess.

And as Christmas drew nearer and nearer, I found myself more and more overcome with panic and dread about holding myself together through our family activities, worrying that I’d ruin them for everyone and inevitably escalating even more.

I couldn’t breathe. I couldn’t think. I couldn’t comprehend.

I didn’t want to live.

So eleven years ago today, my parents—my terrified, confused, helpless parents—and I together made the heart-wrenching decision that I needed to be hospitalized. Two days before Christmas.

The ensuing details are still hazy to me, but from what I can remember: I sobbed on our couch in Greek-tragedy emotional pain as I slowly wrapped my muddled brain around what I was about to do. Mom and Dad came with me to the emergency room. I was evaluated by a doctor. We were put in an empty holding room for four hours while they looked for an open bed, which they eventually—thankfully—found right there instead of in a hospital 200 miles away. We were taken to the mental ward where we first had to go through a room where Mom and Dad had to leave their coats and Mom had to leave her purse.

When we got in, I had to forfeit my coat and clothes and phone and basically everything but my glasses. I was given scrubs and hospital socks. I met privately with a doctor, who took me off every drug I was on and prescribed yet another new cocktail of drugs. Which meant more simultaneous ramping-up-and-down side effects.

And when I was finally done being triaged, I was given an opportunity to say goodbye to my parents and then I was escorted to my room.

I made one last look back as I was halfway down the hallway, and the looks on my parents’ faces—their anguish, fear and inconsolable sadness—will be forever seared in my memory.

And so will my feeling of complete, comforting relief from accepting the fact that all of this was bigger than I was, I could finally release the demons fighting inside me, and I was in the protective, hopefully healing care of people who could manage whatever it was that was tearing me apart.

Eleven years ago today I launched into an unknown of what ended up being a full week in a locked mental ward in a hospital.

Eleven years ago today I started yet another roller coaster of the disorienting, miserable side effects of changing medicines.

Eleven years ago today I finally knew I was safe from myself, I was being cared for by experts, and for some reason what I found to be the most important: I wouldn’t ruin my family’s Christmas. I knew that not being there would be disruptive. But I also knew that being there would have been even worse.

Eleven years ago today, I started what would still be a long, bumpy road to healing, but I knew I was at least on the road to healing. It was one of the worst things I’ve been through and one of the best things I’ve ever done.

If you’re struggling with the out-of-control pain and confusion of mental illness, please know there’s no shame in asking for help—even to the point of being hospitalized—and putting yourself in the focused care of others.

There most likely won’t be immediate healing. But there will be hope. For you, your family and your support network.

There will be calming, restorative, essential hope.

The horrors of Depakote

Facebook is reminding me that seven years ago today was my first attempt at functioning in public (specifically at work) on the hardcore anticonvulsant Depakote:

Depakote either works wonders for you or it destroys you, and I was DEFINITELY on its no-fly list. The pharmacist who filled my first prescription actually pulled me into a consultation room, warned me about the horrible, terrifying things I might experience, and literally held onto my hand as she talked to me. I'll never forget the look in her eyes that was a mix of both kindness and visible concern.

[Don't get me started on the hack Chicago psychiatrist who'd prescribed it without saying any of this to me and who obviously made zero attempt to set up a line of communication should I have problems in my first terrifying, confusing days and weeks.]

Once I got home that night, I took my first dose with much trepidation, went to bed on the guestroom bed my parents slept in on their visits so I could maybe feel somehow close to them if I needed to ... and right on schedule I was immediately flooded with such graphic nightmares of being hunted and murdered over and over that they're seared in my brain and I can still replay them in my head with absolute clarity.

That was a Friday night, and all weekend I'd hallucinate intruders in black hiding in my apartment and wake up screaming when I tried to sleep. But psych drugs can have side effects like these as you ramp up, and I was at least self-aware enough to know (or be pretty sure I knew) that the hallucinations weren't real and the nightmares would eventually go away.

Which they never did. I was taking Depakote with the more established anticonvulsant Lamictal (which I'd been on for years) and at least one other drug (but probably two or three) that I can't remember, and in the weeks that followed it seemed to be the tipping point from barely managing my bipolar swings to living in terrifying hallucinations and falling into daylong blackouts where I'd come to riding the Red Line north to parts of Chicago I'd never been to or sitting on a bench in the Lincoln Park Zoo without my coat or my phone.

I seem to recall that seven years ago today I was able to hold myself together at work, but I do know that the abovementioned blackouts caused me to start missing entire days of work. I can't remember how long I gave Depakote to finally level out in my head and maybe start working, but I do remember it never did. And my hack psychiatrist eventually had me quit it cold-turkey as he threw some other random drug at me. And I was too meek and confused and overcome with self-doubt to challenge him on any of it.

And it was all awful. Just ... awful.

But it DID give me an opportunity to make a big-gay-musical pun (that wasn't half bad, imho) about it on Facebook seven years ago today. So there's that.

And it took another four years before I found my magic psych cocktail that's kept me stable and functioning and able to laugh at everything I went through. Especially that awesome big-gay-musical pun.

And if you're struggling through your own parade of trial-and-error psych meds (hopefully not with that hack psychiatrist at the helm), try to be be patient and diligent and even optimistic about your adventures. I made it. There's every chance you will too.

Not to make things alarmingly about me

but I accidentally took my meds twice this morning like a forgetful idiot and now I'm dizzy and unable to walk and really sensitive to light and barely able to see and slightly nauseated and talking a bit randomly so this post is taking forever to write.

My neurologist took forever to get back to us, but he said just to sleep it off—which is hard to do because I have to wedge my arms under my sides to hold myself in place because I have a weird sensation that I’m going to roll off the couch where I’m spending the day near my doting parents. 

If you’re on either of these meds, never take 600mg of Lamotrigine and/or 1,200mg of Gabapentin (we’re not sure which is/are making me fall into this bizarre hole). 

That’s enough typing.

Giving cigarettes the Axe

My seizure medication (Lamictal, which is being slowly titrated up from 400mg/day to an eventual 800mg/day) hasn’t killed my cigarette-smoke hallucinations, so I’ve resorted to attempting to mask the imaginary stink with one of these plug-in room-smell thingies (in the default—but debatable—Fresh Linen scent):

And even though it’s on the lowest setting and hidden halfway behind a huge piece of furniture, it makes my entire Basement Bachelor BunkerTM smell like a middle-school boys’ locker room the day after a massive sale on Axe Body Spray.

It does mask the cigarette-smoke hallucinations—which get especially strong (or at least acutely noticeable) as I work at my desk—but it’s giving me a low-grade headache.

Even worse, it’s giving me flashbacks to my boyish middle-school waistline, first fuzz of pubescent armpit hair and store-brand parachute pants. Can I borrow some hair mousse?

MRI/OLFACTORY HALLUCINATIONS UPDATE:

My MRI showed no evidence of seizures, but my cigarette-smoke hallucinations are so pervasive and choking that my neurologist had the levels of Lamotrigine—an anti-seizure medication I'm already on to control my bipolar disorder—tested, and since the numbers were so low he wants me to quadruple my dosage.

Quadruple. In one fell swoop. Which is crazy. And since I'm crazy, I KNOW crazy.

So I have a call in to my psychiatrist to get a second opinion. Because it took a decade to test and titrate the med cocktail I'm currently on that finally makes me (relatively—the jury is still out) functional. And I'd rather choke on imaginary cigarette smoke the rest of my life than spend another day in a psych ward with a roommate whose first words to me are that he just got out of prison. Because I've already crossed THAT off my bucket list.

BUTT UPDATE:
The super-handsome leather-clad supposed-to-be-for-a-dining-room chair I use for my work-at-home desk has started leaving crippling pain in my butt and tailbone—please keep your vulgar comments to yourselves—so I ordered an ergonomically designed butt pad to hopefully let me stand up after every hour of writing without shouting epithets at the no-butt-pain gods.

The pad I bought is literally called Everlasting Comfort(R)—which, I'm sorry, should have been snatched up by the funeral industry decades ago, so way to drop the ball, casket-makers—and it's velvety soft and everlasting-comforty cushy and it has a cavernous space for my poor beleaguered tailbone to hang in peace. I can't say the same for the little hill it expects me to rest my boys on, but if I can walk like a bipedal hominid after spending a day writing about pajamas and kitten hats, the boys and I will learn to adjust.

This is my first day riding the Everlasting Comfort Train, and I've been ergonomic-butting and tailbone-hanging and boys-resting on it for six hours of work now. So far it doesn't feel like anything's changed, but that could just be because my existing profound butt pain hasn't cleared itself up yet. So—like Nevada—the boys and I are still tallying votes and we'll announce the results sometime before the peaceful transfer of power.