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.

Mental Health Awareness Month: Bipolar Disorder

I’m starting my series of essays with something I know on a cellular level: I was diagnosed bipolar II two decades ago, and I’ve spent a lot of time since then trying to learn everything about the illness, how the medical community’s understanding of it is evolving, and how we all can work to manage it both day-to-day and long-term.

Bipolar disorder in general involves one- to two-week swings between two opposite poles of mood, energy, focus and function. The top pole is mania, which manifests itself with elation, irritability, energized behavior and lack of impulse control. People in manic episodes experience racing thoughts; an inability to focus or stay physically still; and delusions and hallucinations that can inspire irrational or risky behaviors including gambling, sexual activity and drug use without regard for what can be catastrophic consequences. 

The bottom pole is depression, which manifests itself with hopelessness, indifference and despondency. People in depressive episodes experience extreme sadness; suicidal ideation and attempts; and difficulty functioning, thinking or experiencing pleasure (which is called anhedonia).

There are three types of bipolar disorder. Bipolar I Disorder involves swings between both poles—sometimes both at once—that are so severe they can require hospitalization. Bipolar II Disorder—sometimes called bipolar depression—involves mild manic episodes (called hypomania) and often more profound depressive episodes. Cyclothymic Disorder, which isn’t as common, involves hypomanic and depressive episodes that last at least two years.

As I’ve said, I’m bipolar II, where my hypomanic episodes involve restlessness, fast (well, faster than normal) talking and thinking, and buying shoes online that I don’t need. I usually post these purchases on here to broadcast that 1) I bought awesome new shoes and 2) I’m currently hypomanic off my ass. My depressive episodes are soul-crushing in their extremity. I can’t think, I struggle to breathe, my vision is blurred, I feel like I’m wrapped in a wet wool blanket that I can’t kick my way out of, I sometimes have visual or aural hallucinations (including seeing people in black clothing lunging at me and hearing stupid, irritating circus music coming from another room), and I often contemplate suicide but I have no energy or initiative to carry it out … I generally feel like everything is completely hopeless and I just want to have never existed. And when I emerge from these episodes I’m exhausted to my core.

Bipolar disorders can be managed with psychotherapy (talking with a therapist), psychiatry (drug therapies) or a combination of both. I’ve never found much benefit from my visits with various psychologists, but I’m a HUGE believer in better living through chemistry. Psych meds (which are awesomely called psychotropics) affect me strongly, for better or worse. They involve a lot of trial and error, but I’ve been highly functional for the last seven years after finally finding a magic cocktail of three psychotropics (there’s that cool word again).

I do want to stress, though, that what works for me is indicative only of what works for ME. If you’re living with a mental illness, don’t abandon a combination of therapies that might be working for you just because someone else is thriving on a different combination of therapies. And for God’s sake, ALWAYS TAKE YOUR MEDS.

Bipolar disorders were classified as manic depression through most of the 1900s. In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders (called DSM-III), officially changed the classification to bipolar disorder to reflect a wider range of nuance and understanding of the disease. This paragraph is a broad generalization of the naming history, but I wanted to explain that manic depression and bipolar disorder are essentially the same thing.

There is a lot more I could discuss here, but I want to keep these essays short(er than this one) and digestible for anyone who cares to read them. Feel free to share this with anyone you think might be interested, and I hope to have another short(er than this one) essay posted soon. Stay healthy!

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!

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.

Part of a weird, disconcerting, sometimes terrifying world

Facebook just reminded me that nine years ago I played King Triton in a big, splashy (ahem) production of The Little Mermaid and made my first appearance onstage on a wheeled platform with a Botticelli shell and nothing to hold on to for dear life.

Oh—and my doctor and I decided that playing a principal role in a show that involved being wheeled onstage on a small, Botticelli-shelled platform was the PERFECT time to wean myseof off the demon drug Cymbalta.

If you've never been on Cymbalta, I do not recommend starting. If you've ever stopped taking Cymbalta, you know that doing it in this context was just bonkers. I was always unsure of what exact direction I could find gravity. I was in a constant state of thick, memory-clouding fog. I got what everyone coming off of Cymbalta calls "brain zaps," which is the best attempt at a collective name for an impossible-to-describe colleciton of alarming things happening in my head.

And it didn't help that practically every entrance I made began with me angrily shouting ARIEL! and then struggling to remember what came next.

I barely felt present the entire run. You might say I was notter under the water. But you shouldn't. Nobody should ever say that.

Miss Amantadine Capsule

Day 1 on a new (to me) drug that may or may not help calm all the twitching and fidgeting and rocking and tremors of my tardive dyskinesia.

 
Tardive dyskinesia is an often permanent side effect of any number of psych drugs. It took over a decade to find the right drug cocktail to let me function and participate in life like a normal (ahem) person, and I’ve been really cautious about tinkering with the pharmacology since then—even if it could potentially make my body finally SIT THE FUCK STILL.

 
But my neurologist decided yesterday that I’m at a place where my psychotropics are working (more or less) and I’m able to observe my intrusive thoughts and bipolar episodes and frustrating side effects with a degree of objectivity in case I start to plummet … so he launched me on a new pharmaceutical adventure that I started this morning.

 
So far, the only thing I’ve noticed is a chronic inability to avoid typos at work. But it’s shivery-cold and I’m a feeble 56 and I’m jacked up on Diet Coke and I’ve been snorting a substance I got in a corpse-strewn alley from a one-eyed walking tattoo named Prison Killer Dave, so the cause of the typos is really anybody’s guess.

 
As of this writing, the only real takeaway here, of course, is that Amantadine is a pretty alpha drag name.

Tales from the bipolar coaster

If I've seemed moody or angry or checked out (or currently bouncing off the damn walls) to you over the last few months, I've been really struggling with more-extreme-than-usual bipolar swings ... most have which have taken me to pretty dark places.

My doctor doubled my primary SNRI antidepressant five weeks ago, which sent me spiraling into confusion, delirium and flu-like misery, so she pulled back to half-doubling it (making it just 150% instead of 200%? I'm not sure how to describe this mathly) and it's given me a sense of clarity and presence and optimism I haven't felt in literally years and years.

But it hasn't affected the downward swings. It's a net gain, but it's far from working as we'd hoped.

Anyway, I just got back from a follow-up with her, and we've decided to stay the course for the time being while my brain continues to sort out this new SNRI influx. Maybe we'll go back to the double dose (of the original dose ... again, I'm not good at mathly descriptions) in the next month or so.

But! I'm not seeing her for eight weeks instead of four, which tells me she's seeing all of this as promising.

In the mean time (and retroactively to early October), please don't take it personally if I seem uninterested or unable or unprepared or unplugged. And please don't slug me if I'm bouncing around so much that I knock your heart out of rhythm and make you spill your coffee.

But please always bring me cookies and Diet Coke. I just might give you a wan smile as a reward.

Cymbalta withdrawal is a bitch. Bitch Kitty is a bitch.

Cymbalta withdrawal gives me brain zaps, which are like blackouts with extra dizziness and lip tingles and confusion and disorientation but no actual blacking out. Bitch Kitty gives me the come-pet-my-soft-warm-exposed-tummy fakeout, which is like a real come-pet-my-soft-warm-exposed-tummy invitation but with growling and hissing and swatting and running away as fast as her waddly soft warm tummy will allow but with no actual soft warm tummy petting.

 
Cymbalta withdrawal brain zaps hit me then fade away then hit me then fade away until I'm exhausted. Bitch Kitty swats at me then runs away then swats at me then runs away until I'm tired of her bullshit.

 
Cymbalta withdrawal brain zaps will eventually go away and I will dance on their grave. Bitch Kitty will eventually go away and I'll actually kinda miss her.

When you’re a total stupid dumbass

who absent-mindedly takes your Saturday PM meds when you wake up at 5:00 on a Monday and then a few hours later you take your Monday AM meds and quickly send yourself spiraling into a painful, disorienting, blinding, terrifying—but ultimately non-threatening—double-dose overdose situation last week so your mom devises a brilliant MomGyver fail-safe using nothing but rubber bands and a butter knife to save you from your stupid self in the future.

Also: While most of these pills are supplements to enhance the efficacy of my psych meds, the collective volume of psychotropic and supplemental pills has finally reached a critical mass that obligates me to take them in two shifts instead of in my usual badass single-fistful gulp.

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.

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.

Some people get MBAs. Or MSWs. Or Mrs.'s.

I just got an MRI. And I have the MRI hair to prove it.

My choking-cigarette-smoke olfactory hallucinations are now in their sixth straight sold-out week, so my neurologist ordered an MRI to see if I might be experiencing seizures. And since I was a bit overdue for my every-other-year MRI to monitor a benign adenoma tumor on my pituitary, my GP ordered one for that as well.

For those of you keeping score at home, that's two MRIs for the price of one Richter-scale bedhead.

And hoo-boy has the MRI spa experience improved in the last two years. Instead of being immobilized in a claustrophobic head cage and jammed full-body into the super-duper-claustrophobic MRI oven that clanks and screams at you like you're about to be devoured by robot ghosts, this time I was given noise-almost-canceling headphones with my choice of music (they cruelly didn't have a Broadway option, which is just rude) under my claustrophobic head cage and I was rolled into the oven only to my shoulders, which allowed a welcome sense of light and air circulation.

Side note: The top of the oven hole that I was rolled into was made of pale plastic molded with two ridged arcs that curved in from the sides and swooped down to meet in the middle and disappear at the bottom. And when you stare at them for over an hour as terrifying robot ghosts clank and scream in your ears, they start to look like ... well ... um ... a hoo-hoo. And once you see an abstract hoo-hoo arcing gracefully mere inches from your face, you totally can't UNsee it. So it's fair to say that I've had more than my fair share of molded abstract hoo-hoo for the day. Or the week. Or the decade.

When the guy who locked me in the claustrophobic head cage and rolled me into the MRI clanking-and-screaming-robot-ghost oven told me that Broadway wasn't an option for my musical distractions, I—in a pique of fluster—blurted out the obvious second choice for a Broadway lover: '70s rock. I have NO idea why I said that, other than the fact that I like The Eagles and "Little Willy" (the SONG, ya perverts), but the genre's stentorian guitar shredding and growled, node-guaranteeing singing ended up making an arguably better robot-ghost-clanking-and-screaming cover-up than "She Used to be Mine" or "Finishing the Hat."

Side note: When you're immobilized in a cage with a molded abstract hoo-hoo glaring in your face and an endless parade of '70s rock anthems you've never heard before blaring in your ears, you have to think of SOMETHING to pass the time. So you inevitably find yourself listening intently and trying to catalog the form and structure of each song.

Cliff's Notes: The '70s were clearly a period of unbridled musical creativity and innovation, because not a single song is written in AABA form. Not even "Old Time Rock and Roll," despite its UNAMBIGUOUSLY STATED allegiance to the AABA Golden Age. Thanks for nothing, Bob Deceiveger.

Medical-stuff conclusion: There is a measurably common—though not necessarily causal—relationship between mental illness and pituitary tumors. Which is one reason we monitor my adenoma every two years with an MRI to see if it's growing or in any way changing. There is also an objectively cruel relationship between my bipolar-meds-induced tardive dyskenesia—a permanent neurological disorder that causes LOTS of involuntary muscle movement—and my regular MRIs that require me to LIE THE FUCK STILL FOR OVER AN HOUR and hold all that twitching in. It's exhausting, which is why I always take a PTO day to recover when I have an MRI.

And to tame my damn bedhead.

Of Two Minds

I stumbled on this documentary about bipolar disorder last night on Amazon Prime, and it is so well done that I didn't even pick up my phone as I watched it. Which says A LOT.

The film follows the lives of four people living with bipolar disorder for over a year and veers off once in a while to profile a handful of others, which I think leaves viewers with a robust understanding of the commonalities bipolar people all deal with but really underscores the fact that no two people's experiences are the same. Some people (like me) have hallucinations, some cut themselves, some find manic episodes to be thrilling, some (like me) find them scary and exhausting, some experience functional depression, some (like me) fall into depression so deep that it's past the point of functioning and therefore safely past the point of being capable of self-harm, some attempt and eventually succeed at suicide, some hate taking meds and even refuse to fill their prescriptions, and some (like me) can never forget how awful it is to be off our meds and therefore take them religiously.

The people profiled are straight, gay and bisexual. Some are religious and some are atheists. Some have money and some are struggling so much that they can't afford their meds and rent and seriously consider leaving the United States for a country that can offer them healthcare. They live in cities all over North America. The documentary really does a deep dive into the environments and experiences that shape the way people manage their mental health—though my only criticism is that there are only three people of color, all of whom are just one-off side interviews, which I think really misses an opportunity to paint a more robust picture of experiences and contexts and cultures and personal decisions.

It's edited deftly to be thorough and intimately informational but not overwhelming. I was left feeling emotionally connected to everyone—to the point that I rooted for all of them but ended up angry at one person and genuinely disliking another.

If you or someone you love is living (or struggling) with bipolar disorder, I highly recommend watching this. It's quite beautiful.

Reason #7,963 that it sucks to have no power in prolonged high heat and humidity:

• Your meds, vitamins and supplements get sticky and melty and refuse to come out of your pill box

Pete Buttigieg had another town-hall rally in Cedar Rapids tonight ...

where he continued to inspire and enthrall and impress the hell out of a packed room of supporters and still-undecided caucusers.

His messages of big-tent inclusivity and his standards of decency and his unfailingly measured and principled and educated policy proposals shaped more than his well-rehearsed stump speech; they drove thoughtful, meaningful answers to audience questions drawn randomly from a literal fishbowl in front of everyone. Pete doesn’t just talk for the sake of talking—he has things to say that he’s clearly thought about and taken the time to research and understand and make informed opinions about.

Issues related to mental illness—and caring for people with mental illnesses—came up more than once over the course of the evening, and amid discussions of stigma and a lack of available care and his loan-forgiveness proposals to draw more people into the field, he specifically mentioned bipolar disorder. I was sitting with my dad in the ADA section, wedged between him with his cane and a stranger with hers. My tardive dyskinesia—a permanent tremor disorder brought on by my bipolar meds—happened to be firing on all cylinders tonight, and as I was struggling mightily to sit still and not bounce like an earthquake and jostle everyone wedged around me, my chosen candidate—the measured, educated, thoughtful, egalitarian, inspiring, openly gay, perpetual adult in the room—specifically mentioned ME and my struggles and my family’s struggles ... and he had solid, workable ideas for addressing them for everyone living with our struggles.

And though my meds have also pretty much neutered my emotions and left me virtually unable to cry, I found myself repeatedly choking back tears.

If you’re undecided or overwhelmed or even underwhelmed by the field of Democratic candidates, reach out to me. I’m more than happy to share with you why I find Pete Buttigieg so inspiring and important and eminently capable of leading us all as a citizenry and as a country.

The mind is the first thing to go ...

It’s the second day of the year and I’ve already forgotten to take my morning bipolar meds. THAT’S ONLY A 50% SUCCESS RATE, PEOPLE.

I’ll never be one of the people who decide that they’re all better and stop taking their meds, but I’m proving over and over again that I’m one of the people who are too groggy every morning to remember to take them in the first place. Which is EXACTLY why I have a mother who obsessively double checks for me and I have a three-morning stash of dated backups at my desk.

Onward!

Some dumbass we all know

... has accidentally taken his night psych meds in the morning enough times lately that his mom finally had to make a bunch of big white paste-on labels for his pill containers so he hopefully won’t get so confused again in the future.

I probably shouldn’t have been so cavalier

about living my life effortlessly free and clear on my bipolar meds this morning, because by noon I was sliding into a depressive episode fast enough that I left work and came home to crash. But five hours of sleep and shovelfuls of leftover Christmas comfort food have brought me back from the brink. Seeing Kelly Clarkson sing “Fancy” in tribute to Reba McEntire on Kennedy Center Honors didn’t hurt either. I’m profoundly exhausted, but I think I dodged a bullet by canceling the rest of my day to sleep. Onward!

Tambourine, the forgotten reindeer

As is the case with many people on psychotropic medications, my bipolar meds have given me a robust case of tardive dyskinesia, a permanent neurological disorder that causes a range of involuntary movements including twitches and wiggles and shakes and grimaces and blinks and OCD things like repetitive face touching.

And I've won the tardive dyskinesia lottery and gotten the full spectrum of these behaviors, with varying degrees of intensity. Some days my knees just shiver. Some days I have epic squinting, face rubbing, rocking and anything else my body can think of to make me super-paranoid I'm irritating the hell out of everyone around me. People often ask me if I'm nervous (which happened once at a job interview I was otherwise rocking, to my eternal mortification) or cold (my veins actually course with reptile blood and I am NEVER cold) when they see me shaking. People have asked me why I'm always on my tiptoes when I sit down (the obvious answer: to help my body shake the living hell out of my legs more annoyingly). People have politely asked me to sit still.

And while these awake behaviors are bad enough, it's the nighttime manifestations of tardive dyskinesia that are killing me. Many, MANY times every EVERY night, I end up on my back with my legs bent and my feet flat and my knees slamming against each other so violently that they wake me up—usually somehow mummified in a tangle of sheets. Or I wake myself by repeatedly running my hands through my hair like I'm a supermodel being all sexy for a shampoo commercial as I ride with the top down along the 101. Or I just rub my face like I'm Lady Macbeth but the damn spots got all over everything and I need to URGENT URGENT WAKE UP AND TELL MACBETH TO ORDER DUNKIN' AND NOT MURDER DUNCAN.

Last night it was the face. Hoo boy, was it the face. And it was so borderline violent that it hurt ... and then it stung like an advanced-degree sunburn when the water hit it in the shower this morning. Which—if you see me today—is why I look like Hobo Santa because my cheeks are ultra-rosy and I'm now on my third day of not shaving and I don't care THAT much about how I'm going to look in the family Thanksgiving photos.

I take Gabatentin three times a day to help control the reason I'm extremely bad at stealing tambourines, but that is a six-paragraph discussion for another day. Key words: opiod epidemic

Anyway, this post started out as a few sentences about how my face hurt in the shower this morning and then I was going to show you all a photo of the Hershey's Kisses I bought last night THAT LOOK LIKE LITTLE SANTA HATS. Sorry for rambling on like this, but look at the Hershey's Kisses I bought last night THAT LOOK LIKE LITTLE SANTA HATS: