Mental Health Awareness Month: Tardive Dyskenesia

As if mental illness itself weren’t embarrassing and exhausting enough—and as if the spectrum of side effects from psych meds weren’t even more embarrassing and exhausting—along comes tardive dyskenesia.

Aside from sounding like an antebellum flowering vine, tardive dyskenesia is also a range of involuntary, repetitive neuromuscular movements of the tongue, lips, face, torso and extremities that occur in people treated with long-term antipsychotics and other dopamine-receptor-blocking medications. If you’ve ever stood or sat near me for an extended period of time, you’ve no doubt seen the full compendium of symptoms: grimacing, lip chewing and pursing, heavy blinking, face touching (and I deserve seven gold medals for fighting back the compulsion to touch my face 75 times a minute in the Coronavirus Olympics), arm swinging, leg hitting, rocking, fidgeting, shaking, and—oddest of all—being on tiptoe whenever I’m sitting down. I continue to cringe every time I see a video of me talking or singing with my lower jaw weirdly askew. My foot also pulses on the gas pedal when I drive, and a number of people have told me it almost makes them carsick when they ride with me.

I’m rather lucky in that my flailing and wiggling are more embarrassing than physically problematic, but about 20% of the population living with the disorder literally can’t function; it can prevent them from walking, eating and even breathing.

And as a point of clarification, these symptoms are the opposite of those from Parkinson’s Disease. People with Parkinson's have difficulty managing controlled movement, whereas people with tardive dyskenesia have difficulty managing uncontrolled movement.

Tardive dyskenesia symptoms can lessen, change or even go away over time after a person stops taking neuroleptic medications, though more often than not they’re permanent. My symptoms have noticeably changed over the last decade-plus, but I’ve traded making alarming sucking sounds on my lips for making an entire room tremble from my violently shaking legs.

There are many medications that can be used to manage the symptoms to varying degrees. After five-plus years of needless misery, I successfully weaned myself off the anticonvulsant Gabapentin, which did or didn't work depending on the way the wind blew and the leg trembled. It also tended to make me drowsy and sometimes even confused, which makes me especially surprised that it’s used recreationally—under the totally lame street name Gabbies—for its supposed euphoric effects that I absolutely NEVER experienced.

I also briefly experimented with Amantadine, which started life as an antiviral for treating and preventing influenza A and soon showed promise in treating movement disorders—both on the Parkinson’s and tardive-dyskenesia ends of the spectrum. Used to enhance dopamine release in the brain, it (of course) comes with a barrage of side effects which for me were mostly insomnia and increased orthostatic hypotension, a tendency to get dizzy and nearly (or on rare occasions completeky) black out when I stood up. As with most psych and psych-adjacent meds, it also came with miserable ramping-up side effects and just-as-miserable ramping-down side effects. And it seemed to do nothing but cost money when I was riding the full dose.

On a bad-decision side note: My doctor and I decided to wean me off of Amantadine when I was on one of my annual Broadway binges, and I endured six days and eight shows in an increasing fog of ramping-down insomnia that left me positively catatonic by the time I got home.

One more thing: You may have seen the commercials for the prohibitively expensive tardive dyskenesia medications Ingrezza and Austedo … the commercials where they call tardive dyskenesia “TD” like it’s some cool brand of earphones or energy drink. Dear Ingrezza-makers Neurocrine Biosciences and Austedo-makers Teva Pharmaceuticals: I’ve had tardive dyskenesia for well over a decade. I’ve been seeing psychiatrists and neurologists about it for well over a decade. I’ve read everything I could read about it for well over a decade. I’ve been on medications for it for well over a decade. And NOBODY outside of medical publications and pharmacy websites calls it TD. STOP TRYING TO MAKE TD HAPPEN.

Amantadine day 4

I’m back to having my normal amount of stand-up-and-immediately-have-to-squat-so-I-don’t-black-out episodes. But holy buckets they’re way more intense.

 
Since there’s no way to measure a baseline on these things, I can’t objectively tell if my tremors and wiggling have subsided. I sometimes think they have and I equally sometimes think they have not.

HOLY SHIT WHAT’S UP WITH MY HAIR?

I had planned on going to the gym today, but I slept too late (meaning 11:00 am) and had to dive right into the day’s plans. With yesterday’s prolonged migraine that equals zero trips to the gym over the weekend. But lots and lots of fitful sleep.

 
I think I’m getting a bit of a chest cold. So all measures of Amantadine’s efficacy are essentially contaminated with pestilence, distraction and whining.

 
HOLY SHIT WHAT’S UP WITH MY HAIR?

Amantadine day 3

As is often the case on weekends, I woke up with a migraine that shut me down for most of the day. I even had to cancel my piano lesson, and I was all ready to KILL on the C.P.E. Bach “Solfegietto.”

 
I’ve had many discussions about why migraines tend to hit me mostly on weekends. Maybe I consume more caffeine than I realize during the workweek and I crash on the weekends without it. Maybe my illness-addled brain politely waits until it knows a migraine won’t disrupt any major plans and only then does it unleash the kraken.

 
Maybe someone’s trying to contact me about my warranty.

 
But now there’s the unknown universe of miserable Amantadine side effects in the mix, and I’m just gonna give in and chalk this morning up to that.

I was able to make myself functional enough by 3:00 to work at the meals program where I volunteer. (Side note: The people we’re serving are growing in numbers, and quite a few felt the need to inform us that this was their first time needing to get a free meal. The fact that new visitors are self-conscious and almost apologetic for some reason always hits me the hardest.)

My body and brain had only 50% battery power by then, but I still went to see a superlative production of a show some friends were in. I was seated by my mom, and she pointed out that I was noticeably less shaky. My brain was in crowded-theater mode and I was already subconsciously holding myself still, but the more I paid attention to it, the more I realized I was spending WAY less energy than normal trying to hold myself together. But maybe I was just still exhausted from the migraine.

 
My litmus test is putting toothpaste on my toothbrush. It’s been maybe a year since I started having to set my toothbrush on the counter to get the toothpaste on it because my hands were too shaky to do it when I was holding both things in front of me. And that was still the case just now.

 
But as I sit here typing this, only one foot is swinging and twitching. Usually both are on fire 24/7. It’s really quite remarkable. So I’m cautiously letting myself think the Amantadine is finally letting me SIT THE FUCK STILL LIKE A BIG BOY.

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.

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.

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.

BOOT EDGE EDGE!

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.

Tardive Dyskinesia Citrus Blend Sparkling Water

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.

One of us is a bit twitchy and one of us is a Bitch Kitty

But only one of us can blame our issues on our bipolar meds.

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:

I seem to be having a bit of a bipolar depressive episode today

I’m functional enough that I’m at work, but I’m dysfunctional enough that I. CAN’T. FUCKING. SIT. STILL. Being bipolar is weird.

Plus my boyfriend won’t even talk to me.

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.

The therapeutic benefits of ice cream

Misery is feeling so shitty at work that you have to admit defeat and come home early from the job you love and never want to jeopardize.

Cozy is getting home to find your folks have made up the couch like a bed so you can climb in it the second you get your shoes off.

Happiness is being awakened in time to have a home-cooked dinner with your folks.

Frustration is choking down the newest mountain of evening psychotropics in the hopes that this cocktail will finally—FINALLY—be the magic bullet that promotes social confidence and friendly comfort and eliminates embarrassing side effects like wiggling and grunting and face touching and hair swirling and eye rolling and knee shaking and foot tapping and diminished motor skills in my hands and fingers and time-sucking distractibility with Facebook or rubber bands or the shoes I'm wearing or how many 5 Hour Energies or Diet Mountain Dews I can nurse before lunch.

But there is a mighty cloud of joy amid all that complicated emotional mess: the unbridled happiness I get from slurping up a giant chocolate malt my dad made for me (with extra malt because we're not savages) and enjoying it along with my parents as we discuss the news of the day interspersed with attempts to fix my mom's perpetually broken iPad even though none of us has even a modicum of a clue what we're doing. It's a small gesture of love and goodwill for what I often feel is an irreparably broken man.

Don't cry for me

So I made it through two and a half Evita performances over the weekend without even a hint of the grunting and twitching and wincing and eye rubbing that have been my constant companions on my current cocktail of bipolar meds. But they started to flare up in the second act of our closing show on Saturday night, and by the time I got to my car after the show I was a full-throttle circus clown of grunting and twitching and wincing and face touching and eye rolling and invisible gum chomping. So I regretfully skipped our cast party and came home to hide under the covers. Today at work I was thankfully a few clowns short of a full circus, but I compensated with hand tremors and a pronounced loss of dexterity in my fingers when I tried to open and close shoe boxes so I could write about them or press the button on my key fob to lock and unlock my car. Plus my face is now chronically red and raw from involuntarily rubbing the fuck out of it whether I'm asleep or awake. Plus my left ear has the on-and-off sensation that I've successfully driven a railroad spike in it. I'm frustrated to the point of never leaving the house again, but there are shows I want to be in and people I want to meet and uncling I want to do and acres of shoes I want to wear and maybe another marathon I want to tackle and family happiness I want to enjoy. And thanks to an after-hours call with my psychiatrist tonight, I have a new med to get my hopes up over. So I'm heading to bed with a new psychotropic joining my existing army of four and wondering which Jake I'll be in the morning. Good night to all of you who managed to slog completely through this endless manifesto. And thank you to everyone who calls or texts to see how I am. I may not have a coherent answer every time but your friendships mean the world to me.

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.