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.

Amantadine day 2

I was noticeably more light-headed all day, but in a slightly loopy way and thankfully not a stand-up-and-black-out way like I was last night.

My ears have been screaming EEEEEEEEE! at me all day. Seriously. EEEEEEEEEE!

I had two video calls at work where I could see in real time how much I was fidgeting and rocking and twitching.

 
It’s breathtakingly exhausting spending all my energy trying to hold myself still, so I was very glad to climb under a blanket and a cat after work and nap on the couch (see photo).

Amantadine isn’t a psych drug, which would usually require me to endure weird (or uncomfortable or downright miserable) side effects for a few weeks while I waited for its efficacy to manifest or not manifest itself. So I’m in uncharted territory here as far as what to expect and how long to tolerate it before I decide whether or not the drug is doing its intended job.

 
Originally an antiviral used to prevent Influenza A, Amantadine is now primarily an antidyskinetic used to help control the palsies and involuntarily movements of Parkinson’s disease and my close personal friend tardive dyskinesia.

 
The only other tremor-control drug I’ve tried is the anticonvulsant Gabapentin, which didn’t seem to do anything for me except on the morning when I accidentally took two doses and literally felt like my heart was stopping and my eyes were crossing so hard that my optic muscles might rupture. So, yeah. I immediately started weaning myself off of THAT trainwreck-in-waiting.

 
If I were to judge Amantadine after just these two days I’d say it’s an abject failure as a tremor suppresant because I’m exponentially more twitchy and tremory. My increased orthostatic hypotension (my tendency to experience blackouts or near-blackouts when I stand up) is pretty alarming to me. And I disconcertingly need to monitor myself for a potential skin rash called Livedo Reticularis, which my neurologist and I both agree would be a fun, indeterminately ethnic drag name but that he warned me is also a very dangerous development potentially worthy of a trip to the ER.

So for now I sit (and twitch and rock and tremor) and wait. I think I’ll give it a week before I decide if these side effects are worth enduring—or if I even think the drug is working. I’ve lived with and learned how to manage tardive dyskinesia for 15+ years, so I’m in a devil-you-know/devil-you-don’t holding pattern until I decide which devil to live with (spoiler alert: I’ll probably pick the one with the cutest butt).

In the mean time, I have a kitty to snuggle up with …

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.

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.

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.

Whee!

My tardive dyskinesia—the permanent, involuntary-movement-causing neurological side effect of my bipolar meds—is firing on all cylinders tonight. I’m shaking and twitching and lurching like a sloppy drunk swatting mosquitos on a pogo stick during an earthquake right now. But my week’s obligations are over, I’m finally home, and I’m gonna find a quiet room where I can just go and WIGGLE.

I just had my six-week checkup

(I'm still crazypants biploar but things continue to be stable and we're not altering my meds this time, thanks for asking) and when my psychiatrist met me in the waiting room she asked me if it was OK if a residency doctor observed my visit and of course I said yes because I'm clearly not a hide-my-crazypants-biploarness person and when we got to her office and she opened the door and he was politely standing there waiting to shake hands and introduce himself OH MY GOD HE WAS TALL AND HANDSOME AND LET'S NOT MINCE WORDS HERE HOT HOT HOT and we sat down for my visit but I kept looking over at his let's still not mince words here sexy forearms because that's all I could see besides his face because he rudely wasn't wearing a Speedo and WHY ARE YOU SO HOT STOP DISTRACTING ME and we talked about all the usual stuff like my moods and my appetite and my feelings of control and my ability to concen OH MY GOD I CAN'T CONCENTRATE BECAUSE JUST LOOK AT HIM HE'S TOO HOT TO WALK THIS EARTH trate and any side effects of my meds (still lingering exhaustion, but thankfully it's not 24 hours a day like it has been) and is there anything else I think would be relevant to tell her WHY ARE YOU TALKING TO ME HAVE YOU EVEN NOTICED THE LET'S AGAIN NOT MINCE WORDS HERE HOT HOT HOT MAN WHO'S ABOUT TO BE A DOCTOR AND I THINK WE CAN ALL AGREE IT WOULD BE A VERY GOOD THING FOR ME TO MARRY A DOCTOR AND HE'S SITTING IN THAT CHAIR RIGHT THERE SO CLOSE I COULD STARE AT HIM FOR HOURS WHOOPS I JUST DID and I said that I've actually ramped up the activities in my life like Follies rehearsals and editing a massive book pro bono and making my bedroom renovation finally really start to happen and cleaning out the storage room in our basement AND WHY WHY WHY DOES THIS INSANELY HANDSOME MAN HAVE TO KNOW I'M CRAZYPANTS BIPOLAR PLUS NOW HAVE A DOCTOR-PATIENT RELATIONSHIP WITH ME BECAUSE THAT PRETTY MUCH GUARANTEES THAT'S THE ONLY KIND OF RELATIONSHIP WE'LL EVER HAVE BUT HOLY SHIT WE'D LOOK HANDSOME IN OUR WEDDING PHOTOS and she gave me some more free samples of my really expensive medication and we scheduled my next six-week visit AND FOR THE LOVE OF ALL THINGS GOOD AND HOLY MAKE SURE HE'S STILL RESIDENTING WITH YOU WHEN I GET BACK IN SIX WEEKS and I think we had a really productive visit.

Darkness and peace

I'm sitting in the half-dark watching and listening to my mom as she struggles to find a peaceful, restful balance between gasp-inducing pain and the loopy uncertainties of prescription pain medication 36 hours after undergoing shoulder surgery. She was told she'll probably need to sleep in a recliner for 6-8 weeks as she recovers, so she's now wrapped in an almost structural configuration of blankets and pillows arranged to keep her comfortable and stabilized and not too hot and not too cold on a borrowed electric recliner in our living room as I sleep on the nearby couch with a three-hour alarm set in perpetuity on my phone to ensure I give her her pain medications consistently on time.

This woman spearheaded a full-family battle for my health and my very sanity for years as my escalating bipolar depression clashed with a literally bewildering array of ramp-up and withdrawal side effects from increasingly desperate attempts to find the right cocktail of psych medications for me. My parents have helplessly watched me twitch and yell in my sleep, crawl like a blinded animal up the stairs from a drug-onset migraine, lie gray and unmoving in a hell of despondency in my bed, land in the ER after a blackout and a crash to the floor that was so catastrophic that the nurses assumed I was the victim of a violent assault, and stare emptily but gratefully back at them as they admitted me to a locked psych ward for what ended up being an eight-day stay. They've fought for me, they've stood by me, they've repatriated me ... and now it's my turn to start paying them back.

Mom seemed to be doing remarkably well in the first 24 hours after her surgery, but then the last of the nerve block wore off and waves of breathtaking pain started surging through her reawakened nerve channels, and we've watched helplessly as she's whimpered and cried and tried to keep a brave face through her pain and confusion and unsure self-awareness. But she knows she's loved and being cared for and watched over with the attentiveness she's given my whole family over the years. And she seems to be sleeping comfortably and productively at the moment.

I should be asleep right now too. The couch is all made up next to me and it's quite comfortable; this I know from endless days into nights into days that I spent on it as I fought my way back to sanity while sleeping as close to my parents as I could if I needed anything. But I'm rather enjoying sitting here with her in the dark, post-midnight quiet. The war-zone explosions of fireworks that kept alarming her and waking her up a few hours ago have died down, I just woke her to give her her midnight pain meds and a popsicle, she seems to finally be sleeping comfortably and restfully ... and her partial helplessness and need for me have me thinking that there will soon be more medical problems and more nights like this for both my parents ... until they simply won't have any more medical problems ever again. And I want to remember and savor these moments where I can care for and love them the way they have done for me.

When I got out of the hospital two and a half years ago and spent the next two years fighting to regain my own sense of normal, it became clear that I was going to spend this newest chapter of my life under their care. In return, I've promised them that I'll do everything in my power to keep them in their—our—home as long as I can as they get older. Because I can't imagine taking care of them any other way.

So here I sit. Watching the mother who showed me without fear or reservation how to love me and all my psychoses unconditionally as she suffers through what by all accounts will be a painful but successful healing process. But it is undeniably a harbinger of the future in our home. Which is scary in the abstract. But right now it's a present and a future managed with love and commitment and a deep, profound honor that I am able—in no small part from the lessons and examples my parents have provided for me all throughout their selfless lives—to care for them in the way they cared for me.

And it's all very peaceful.

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.

High five!

So the night I finally vow to everyone from my mother to the straining-to-be polite fitting and training technician lady that I'm FINALLY going to unpack and figure out and actually use my month-plus-old CPAP machine, my eight-good-day streak on the psychotropic that initially made me black out and rip up my face has ended.

Fuck.

I'm heartened that I haven't fallen into depression or anxiety, though those are things I know how to handle. Tonight I'm in a weird, unprecedented, floaty, dizzy, skin-hurty, face-touchy, eye-rolly, pig-grunty, unfocusy, shivery otherworld where gravity feels crooked and it's freezing hot and I should be asleep and I promised myself I'd limit my whiny bipolar shit on here but posting from the middle of the hurricane somehow helps me center myself and give me a record to look back on when I'm good to maybe help me to better anticipate and and ride out when I'm bad and even though my parents are upstairs and my sister's family is a mile and a half away and all of that is profoundly comforting and strengthening, talking about all of it in rambling detail in a public post—where friends and strangers can read it or not read it or like it or ignore it or block it—actually quells the confusion and fear and loneliness. I know it sounds dumb. I know it sounds Munchausen syndromy. But I also know it helps.

So in addition to my yes-I'm-still-wearing-it ulnar neuropathy arm splint and my perpetually bloody, Jell-O-y face scars and now my who-knows-what's-gonna-happen CPAP machine, I'm piling on my floaty, dizzy, skin-hurty, face-touchy, eye-rolly, pig-grunty, unfocusy, shivery, otherworldly, I-truly-feel-better-for-posting-about-ity psychotropic side effects and taking the best possible left-handed fight-the-man selfie I can with my compromised superpowers and crawling into bed.

My little New Year's Eve gathering fell through tonight

So I'm sitting home alone (well, my parents are snoring contentedly in their bedroom down the hall) by the light of the tree with Bitch Kitty glaring at me from across the room and a LOT of oh-my-god-these-are-AMAZING Hy-Vee fudge brownies on the counter. And if you don't live in a Hy-Vee state, it pains me to tell you this but you have wasted your entire life eating really shitty brownies.

But from my safe, cozy—albeit admittedly lonely—perch on our extremely comfortable couch in these last hours of an emotionally contentious year where our country seems to have lost a disproportionately high number of beloved celebrities but I landed a job I love in practically every way and where I have continued to ramp up and ramp down and suffer side effects and endure withdrawal effects of countless psychotropics in my ongoing struggle to beat bipolar depression but in the process my love and appreciation and respect for my family have grown stronger and deeper and more joyous and hopefully more reciprocal, I can't help but harbor grave concerns about the coming year.

I'm concerned to the point of being terrified of the pending horrors wrought from the blind nationalism and the arrogant ignorance of the inchoate and yet already alarmingly destructive Trump kakistocracy. I worry that the gloriously revolutionary American Experiment will fall way too early in its young life at the hands of a predatory, self-serving demagogue who stupidly let himself become a political puppet in a game of nuclear chicken that could precipitate national, international or global destruction. I also worry greatly that our educational systems and standards and our national and local infrastructures and our economy and our safety and even our civility will collapse in the process or the aftermath.

On a personal scale, I worry that friendships will end and loved ones will die and control will collapse and accidents will cripple and ideologies will interfere and dreams will fail and fortunes both monetary and emotional will fall and I know these worries are universal and though they can easily isolate us they can also unite and inspire and ultimately augment us, but they still compel me to hold my family and friends close and keep my guard up and my emotions girded and my world as calm and controlled and constant as I humanly can.

So much can change in 365 days. Three years ago I wrote international ad campaigns for a prestigious agency in Chicago. Two years ago I was in a locked psych ward, so pharmaceutically emotionless I couldn't even cry. One year ago I was somehow holding onto a job I wasn't even good at but I was apparently charming or earnest or possibly overlookable enough that I survived months of staff reductions. Now I'm proudly living with—and providing reciprocal care for—my septuagenarian parents, working happily as an online product copywriter for a gloriously high-end international retailer, regularly singing and dancing and acting and sometimes just smiling and waving in shows for three different theater companies, discovering the unimaginable joy and love and pride of playing uncle to two intelligent and kind and talented and responsible and remarkably tall young adults who thankfully possess an inherent and reciprocal and mutually straight-faced understanding of my meandering and maybe-just-a-little-bit-perhaps-over-the-line sense of humor, and still clinging confidently to the hope that I will soon find the right psychotropic cocktail to regulate my bipolar depression plus find a boyfriend who loves theater and Hy-Vee brownies and running and tattoos and underpants jokes and freakishly conspicuously indulgently long sentences and living in Cedar Rapids where hopefully our entire families are.

So I face this new year with great but guarded trepidation tempered by a glorious spectrum of hope and joy and gratitude and love and oh-my-god too many shoes and a fervent hope that the coming months are filled with peace and diplomacy and respect and common sense and a governance guided by a deep, profound, nuanced, reciprocal knowledge and understanding of who we are, what is fair, how we're responsible, and the selfish and bellicose and irreversible and potentially catastrophic options we should never even pursue.

And—you're welcome—to end this post and start this year on a far less cataclysmic note, I can report with complete confidence that (at the very least) the first months of 2017 will be filled with staggeringly long, shamelessly self-indulgent, thesaurusly verbose, hopefully thoughtful, possibly funny, relentlessly selfie-enhanced posts.

And since tonight's get-together didn't happen, the dawn of our new year will also be filled with Hy-Vee brownies. Lots and lots of Hy-Vee brownies.

Happy New Year, everyone.

Here's some friendly midnight advice from your crazy Uncle Jake:

If any doctor tries to prescribe a psychotropic drug for you, the FIRST thing you need to ask about are the withdrawal side effects you'll endure when you stop taking it, which—trust me—you eventually will. The ramp-up and day-to-day side effects of taking psychotropics definitely come with their challenges, most of which are a welcome trade-off for eliminating the mental-illness symptoms they were prescribed for. But eventually something in your head will change for the worse and your doctor will start to tinker (rather blindly) with the drug or cocktail of drugs you've been having success with. And the fallout can be unpredictable and devastating.

I ended a seven-year relationship with Abilify over a week ago because within the last year I'd developed a hefty case of tardive dyskinesia that made my legs shake involuntarily, uncontrollably and—most important—embarrassingly. And my current doctor was pretty maybe kinda sure Abilify was the culprit. And at first it seemed she was right. The leg shaking started disappearing almost from the moment I started tapering my dosage.

But.

The leg shaking seems to have been replaced with a three-ring circus of embarrassing side effects: involuntary eye rolling, power squinting, face rubbing, scalp swirling, nose pinching, beard rubbing, chomping, grunting, hyperventilating, spasms down the back of my neck, and an increasingly obvious sense of fogginess and confusion—all of which started manifesting themselves since I took my final tapered dose of Abilify. I'm so miserable I can hardly stand it. And my face is raw from the constant rubbing.

I have two choices: Go back on Abilify and (maybe) trade back my new side effects for my old ones, or stay the course and endure the withdrawal side effects until they (hopefully) go away. I have NO intention of reliving the withdrawal side effects I've survived to date so I'm going to stick with the plan and hope for the best. But I can honesty say that if the doctor who first prescribed Abilify for me could have impressed on me the degree of severity and misery I'd have to endure in my eventual withdrawal, there's no way I would have started taking it. There have been entire days over this last week where depression seemed exponentially easier to endure than withdrawal. Hands down.

You know that fogginess and confusion I mentioned two paragraphs ago? And you also know how in real life I'm a professional writer with (if I may indulge in some immodest immodesty) a quick wit and some mad typing skilz?

It took me almost two hours of intense concentration and multiple fits of intense face rubbing to write this, what should have been a 20-minute post. And I'm beyond the capability of proofing it.

How to keep your friendly neighborhood pharmacy solvent:

I mean seriously. And I take just as many meds in the mornings as well. Granted, about a fourth of my daily pill pile—which is a totally awesome band name—is OTC stuff with purported powers to control the side effects of all this pharmacology. But none of any of it seems to be working for shit. I'm still shaky and chompy and chubby-tummied and chronically, relentlessly exhausted. I'm still struggling to claw my way out of deepening pits of depression on an almost weekly basis. The unnerving and sometimes terrifying symptoms of my Cymbalta withdrawal seem to be escalating. And I'm weaning myself off of Abilify next. BECAUSE NONE OF IT SEEMS TO BE WORKING. Despite my many plans to the contrary, I pretty much slept my way through this entire weekend. I didn't go to a play I had tickets for. I didn't help my brother-in-law paint his house. I didn't do any half-marathon training. I didn't go to our neighborhood block party. I didn't even take a fucking shower.

But I have hope. And the greatest support network a bipolar person could ever ask for. And the ability to sit back objectively and make fun of the absurd and ridiculous stuff. And the delusion that I can stubbornly will myself to get better. But not, unfortunately, the ability to swallow two daily handfuls of pills without violently gagging. And clearly I don't have the self-control—or maybe just the self-sufficiency—to shut up about it all on social media. Which, on some levels, makes all of you part of my support network too. Which I suspect may be my subconscious goal with all this whining. So sorry to drag you all into my mental drama here. But thanks for playing along. I'm going to sleep now. Which I'm really good at; I practiced all weekend.

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.

Today was day 10 of s l o w l y weaning me off Cymbalta ...

... the act of which gave me seizure-like blackout thingies when we did it rapidly last spring. I should be completely Cymbalta- (and seizure-like-blackout-thingie-) free by the beginning of October, at which time we start weaning me off of Abilify. Because I'm on five psychotropics right now, and while saying “psychotropics" is fun and all, five (plus my thyroid medication) is a bit much.

Every time we change my meds (I mean psychotropics!) I get my hopes up that THIS TIME will be the magic bullet and I'll finally stop sleeping through life/binge-buying shit I don't need/growing an enormous gut/hearing noises in the other room/deciding nobody likes me/shaking like a hoochie mama in a bathtub with a toaster. And every time, my symptoms seem to shift around a bit but never totally go away. So now instead of adjusting/introducing meds, we're taking them away entirely. And s l o w l y. But like everything related to psychotropics (there's that word again!), results (or complications) take time. And we have to map out when those results (or complications) might manifest themselves so they won't interfere with things like vacations, projects at work, family events, theater commitments and Disney half marathons. 

Speaking of which, the Disney half marathon I'm running is the first weekend in November, at which time who the heck knows where my meds (and my brain) will be. But once again, I choose to think that by then I'll be clear-headed and focused and energized and bedecked in my red running shorts with huge yellow buttons on the front and—aside from the aforementioned shorts—perfectly normal. Just like all of you magically wonderfully perfectly normal people. (You'd tell me if you weren't normal, right?)

Beware the Withdrawal Effects of Cymbalta

I've been sailing along for months and months on a cocktail of four bipolar meds and one thyroid med with only two problematic side effects: unceasingly shaky legs and all-but-debilitating chronic exhaustion. So my doctor decided to wean me off of Cymbalta over the last week. Which, in retrospect, was probably not the smartest decision to make at the confluence of tech week for one show, early rehearsals for a second show and the week before I start an exciting new job. Throw in a dreamy new boyfriend and a paternity suit with a traveling stripper and I'd be Maury Povich GOLD right now.

Anyway, I've been off and on more meds than I can count with zero noticeable side effects ever. Until today, when I started getting hit by wave after wave of what I can only try to describe as shivery hot carbonation under my skin. It's like the waves of nausea you get with the flu … only there's no nausea. Plus it's like the prickly head rush and the near blackouts you get when you stand up too fast … only it happens no matter if I'm sitting, standing or lying down. A little Googling of Cymbalta withdrawal tells us this is actually a common side effect, but I was never warned about it. And after a conversation with the on-call psych doctor and a trip to one of the only 24-hour Walgreens in Cedar Rapids, I'm now back on a lower dose of Cymbalta for the time being. So the shows and the job are saved. And if you're a potential dreamy new boyfriend, you know where to find me. I promise that the traveling stripper meant nothing to me.

I'm really tired of the tummy my bipolar meds gave me

REALLY tired of it. Cutting back on pop and sugar and fatty foods hasn't changed it. Taking HydroxyCut hasn't changed it. Adding a brutal abs workout to the end of every workout hasn't changed it. So I just hired a trainer. We meet for the first time in 10 minutes. And she's a girl. A girl covered in tattoos and piercings and filled with the kind of badassery I need to whip my midsection - and everything else - into badass shape. And I can't wait to get my ass kicked by a girl!