That's what I'm doing right now. Procrastinating. Writing this post. I've been looking up random shit on the internet instead of writing. For a couple reasons, really. One, I'm depressed, and sometimes I want retail therapy when I'm depressed (hence looking up shit to buy on the internet), and two, I'm depressed and emotionally drained and writing is sometimes difficult when I'm like this.
Wait.
Let's go further back.
To Sunday. Sunday was a bad day for my depression. Very bad. The highlight of the day was seeing Big Hero 6 - a funny movie that was pretty epic.
Monday. Monday wasn't great. Had some suicidal ideation (it would be so easy to take all of my seroquel and just go to sleep . . . just sleep and not wake up . . .). There was that, and that's bad enough. But around 3 my tummy wasn't terribly happy with me. Around 5 it was kinda angry. And then after dinner my ENTIRE INSIDES waged war on me.
That's right. Food poisoning.
I was stationed on the toilet with the trash can in front of me for almost 2 hours. The stomach cramps left me moaning in pain, hyperventilating and both cursing God while begging him for mercy (you son of a BITCH PLEASE make this stop . . .). I stripped down to nothing because I was sweating so much from my misery. Hubby tried to help, which involved getting me some water and watching helplessly as my gut tried to kill me.
What made my shenanigans worse was that I couldn't take my meds. Nope. Even water was making my intestines angry again.
So I couldn't sleep. See, my body is now wholly dependent on seroquel for sleep. Stupid, right? And my stomach was churning and gurgling and angry and nauseous . . .
But by 12:30am I couldn't take it anymore. I got up, had a slice of bread, and took one seroquel (I usually take 2). I figured, hopefully one won't upset my stomach as much as two, and it should be enough to go to sleep.
Nope.
Too little too late I guess. Or my tummy issues were enough that I wouldn't sleep no matter what. I finally fell asleep around 3:30 and promptly woke up at 5. Yay! So much sleep!
I had therapy at 8:30 yesterday morning. I'm depressed, my stomach is still all wonky, I haven't had coffee thanks to stomach wonkiness, I'm tired, and now I have therapy. It was a long session. And exhausting (it would have been exhausting even if I had gotten sleep).
We're trying to figure out the depression thing and M has a way of challenging me and my thinking. Which is good. That's what he's supposed to do. So I'm telling him how I have an appointment with a new psychiatrist on the 27th, that I'm no longer going to see Mary. "And so you'll make sure to tell this new psychiatrist that if he says something you don't like, he'll be fired too," M quipped. I glared at him. "No. That's not what I'm doing", I growled. "Chika has always been very business and short and cold. Mary, the first time I saw her, said that I didn't have to be depressed all the time. That we should be able to manage the depression so that I could actually feel good. And NOW she tells me that meds won't help and that I need to figure out how to deal with feeling suicidal every day. That is NOT OKAY in my book!" I almost spit at him. "Even if that's what you believe, you don't tell your depressed, suicidal patient that."
I lean back against the couch. I didn't realize I had crouched forward, wringing my hands. "I've been seeing them since June. I've given them a fair shot. They took 2 months to get my med prescriptions straight and their secretaries are horrible. And good luck getting seen if you have an emergency - they already double book appointments." M nods. "I just want to make sure you have realistic expectations," he says.
Yeah, well, I probably don't.
"I don't know what to do med wise," I say. "See, I've been doing 'research'", I make air quotes, "on what was going on this past summer when I was the most stable. I was stable when on geodon and brintellix. But we had to stop the brintellix because of the anxiety and then switched from geodon to seroquel to try and help the depression. Well, there's no difference in my mood between being on 50mg of seroquel vs 600mg - except for more pronounced side effects. So what's the point of that? There's no point!" I stop a moment, rubbing my temples. Everything is so muddled. "My thinking is slow. I'm sorry." I wait a minute. My thinking is slow, but my thoughts are racing. So many things I want to say but they're not coming out. "Okay, so Mary had mentioned that I need to do trauma work, right? And so did the doc in Boston. Okay. Trauma work. We've been doing trauma work almost every week since the middle of June. We've done that. We went over my past relationship and rape almost 2 years ago and I'm comfortable with that. We've been going over the ACOA stuff for a while now. I'm going to Al-Anon. I'm doing stuff in workbooks on my own. And honestly? If you were to say, right now, what do yo need to say about your mom, I would have no idea what to say. I have no idea what more to talk about. We went to her house Christmas Eve morning and it was good. I've been texting her here and there and it's been good. I'm not feeling triggered by that like I used to be. I've invited her and her boyfriend over for dinner. She's respecting my boundaries and I feel good about it. Is there more stuff to work through? Yeah, there probably is. But I don't know what it is until it punches me in the face, I guess. Point is, I don't know what more to say, I'm comfortable with her, I'm not getting triggered like I was . . . so what then? What do we do when this happens? She says trauma work but I don't know what more to do with trauma work." Big sigh. I don't know how much of that makes sense.
"That was really nice," M remarks. "That shows how much progress you really have made. You've kind of come full circle and you're recognizing it. You have done a lot of work. You've made a ton of progress. You really are exceptional."
I blush. "I wouldn't say that . . ." Truthfully? I have done the work. I've been in therapy for 3 years. Weekly sessions almost the entire time. And I have learned a lot. I recognize me errors of thinking and then stop and replace them with positive things. I'm doing much better at mindfulness - being present (I'm not great, not perfect most of the time, but I try all the time). I'm truly taking things one day at a time. I'm recognizing triggers and either avoiding or minimizing them. I'm trying not to isolate. I do positive readings, track my moods via chart and mood diary, take my meds, go to therapy, keep a regular sleep routine, am cleaning up my diet, trying to get back into exercise . . . I'm not exceptional, no, but I'm doing the fucking work, that's for sure.
"No, Cami, you are. And with all of this, maybe this depression is a bipolar chemical thing."
I nod. I'm hoping it's a bipolar chemical thing. It has to be a bipolar chemical thing. Why? Because look at all the shit I've done. All the shit I'm constantly doing. If this isn't chemical? Then what the fuck else am I supposed to DO??? Seriously. There's not much more I can do. I'm trying a DBT group. I met with the therapist who runs the group yesterday and my first session is next Monday. It meets every other Monday. So there's that. I guess I can always try neurofeedback (but there aren't any good studies on it, it's expensive, and insurance doesn't cover it). Then there's good 'ol ECT. Which is not even choice for me.
Truth is, I'm doing everything I can. So if this new psychiatrist tells me that changing my meds, in what ever way, is not going to help . . . I have no idea what to do. Because I'm doing everything I can already.
M wanted me to describe an acceptable level of functioning for me. Here it is: I would like to be able to enjoy my husband and son. I would like to enjoy their company and doing things with them. I would like do enjoy doing things. I would like to not have suicidal ideation every day. I would like to not hate my job. I think that's pretty reasonable. I think that's pretty realistic. M thinks so too.
And I know that that's not a destination. I know it's a journey, something M always points out. I know that I'll always have to manage my moods and triggers and meds. I get that, I really do. I hate it, but I get it. It's a lifelong journey. I just don't think I should have to spend so much of it so depressed that I want to die. Is that so much to ask?
I know I've had a lot of posts about this lately. It's been bugging me. Trying to figure out what is going on and how to best handle it. I don't know what is bipolar or PTSD or situational or environmental . . . I don't know. I just want to feel better.
Showing posts with label PTSD. Show all posts
Showing posts with label PTSD. Show all posts
Wednesday, January 7, 2015
Saturday, December 27, 2014
New pdoc?
I'm planning on switching pdocs. I was a bit displeased with mine at my last appointment.
(To refresh your memory, she told me that meds won't work on me and that sometimes people have a black cloud over them and are suicidal all the time and you just have to get used to it)
That rubbed me the wrong way. And by "rubbed me the wrong way", I mean pissed me off, had me sobbing, and stole away any hope I still had left of managing my depression. I couldn't believe she told me that. I mean, even if she was thinking that she shouldn't have told me that. Not when I'm depressed, suicidal, and losing hope on my own.
Not the best thing to say.
Hubby and a couple of my friends have told me to find another pdoc. That what she said was unacceptable. That it seems she's throwing in the towel. Meds won't work on you.
I am torn though. I keep thinking, what if this is all me? What if meds won't work for the depression and that I do just need to do more trauma work? What if this is a situational type of depression, that I have to buckle down and plow through and it's all on me?
What if?
What if I'm changing pdocs because I basically didn't like what she had to say? Maybe changing pdocs won't help anything. Maybe the new one will say the same thing. Maybe I'm just chasing meds, looking for the easy way out.
I look back at myself over the last 3 years, trying to see patterns, trying to see what I'm doing right and what I could improve on. I'm trying to be open and bluntly honest with myself. I need to be if I'm going to get stable.
One thing Ive noticed (and I picked up on this about a year and a half ago) is that once I start to get better I'll be better for a couple of months and then relapse. I get depressed again. And a year and a half ago M (therapist) and I discussed this. We talked at length my "not wanting" to get better. We worked through it, we found and worked through a few triggers, and having me identify this flaw within myself had curbed that tendency to self sabotage.
And I look back and I see no self sabotage for my mania (and hospitalization) last November, no self sabotage for my suicidal depression (and hospitalization), last December, and no self sabotage for my suicidal depression (and hospitalization), last May. I find no trigger, no form of self sabotage - it just happened.
July and August this year I was starting to become more stable. In October I started to slide, by November I was down and getting worse, and December has been horrid. I know I had one trigger: a piece of Al-Anon literature I read on forgiveness. It gave me icky feels. I worked through these feels in Al-Anon, in therapy, and with my hubby. I worked through them. I laid them to rest.
Now, knowing that was a trigger, I was doing all the proper things to counter the emotional response. I talked about it, I journaled my feelings and thoughts, I countered my negative thoughts, I didn't catastrophize, I did everything right.
I worked through it. I felt better about it, and felt that I had nothing more to say on the matter.
Several weeks later is when I really started to spiral. I did all of my CBT stuff that I've learned about, I talked to hubby and in therapy. I didn't let myself isolate - I forced interaction. Again, doing everything right.
So what the hell is going on?? Did I have a PTSD trigger that threw me into a bipolar mood episode? Is this just PTSD? Is this just a bipolar shift with no real trigger? Does it really matter?
Because here in lies the rub: I'm doing all my CBT things, I'm trying to stay present, stay in the moment, take it day by day (sometimes moment by moment), counter my errors of thinking, not isolate, trying to "fake it till I make it" . . . all the things I should be doing.
But they're not helping.
They should be helping. If this was all me, all PTSD, all a trigger, then this shit should be working. And it's not. M pointed out that that one Sunday at work where I was crap and laid on the floor for 2 hours because I was suicidal and didn't know what else to do was most definitely not a trauma issue - it was most definitely a chemical imbalance issue.
If all my behavioral therapies are not working that would lead to a chemical problem, right? So meds, right?
But my pdoc won't prescribe me anything else because she believes this depression is all trauma, all in my head. That if I do more trauma work I'll be fine.
I don't even know what to talk about trauma wise anymore. I really don't. We've gone over my abusive relationship and rape. We've gone over my dad's death. We've gone over stuff with my (alcoholic) mom several times. I don't what else to say on these matters. I have no idea. I don't even know what to say in Al-Anon anymore (I've been silent the last three sessions cause I have nothing to add).
So what more trauma work do I need to do??
There's only one area I see where I need more work: fake it till I make it. I've been faltering in this area. Why? Because it's hard to pretend to be positive, to be okay, to be well, to be not depressed. It takes so much energy and it's so much easier to give into the depression. It's better for me to fake it, it is. But I've been so tired lately, the past few weeks, that it's gotten harder. It's easier to give in. To not fight. See, part of me wants to give up. I'm tired of fighting my moods everyday. I'm tired of the knowledge that I'll do this for the rest of my life. It's too much to handle and so I'm slacking on forcing myself to seem okay (even when - especially when) I'm completely broken on the inside.
What the fuck do I do? Change pdocs I guess, see what the new one has to offer. I don't know. I don't even know. This is all very frustrating as fuck.
Also? I've noticed that since I've been on 600mg of seroquel my cognition is suffering. I forget letters in words or add extra letters, it's taking longer for me to think things through, to respond. Joy.
(To refresh your memory, she told me that meds won't work on me and that sometimes people have a black cloud over them and are suicidal all the time and you just have to get used to it)
That rubbed me the wrong way. And by "rubbed me the wrong way", I mean pissed me off, had me sobbing, and stole away any hope I still had left of managing my depression. I couldn't believe she told me that. I mean, even if she was thinking that she shouldn't have told me that. Not when I'm depressed, suicidal, and losing hope on my own.
Not the best thing to say.
Hubby and a couple of my friends have told me to find another pdoc. That what she said was unacceptable. That it seems she's throwing in the towel. Meds won't work on you.
I am torn though. I keep thinking, what if this is all me? What if meds won't work for the depression and that I do just need to do more trauma work? What if this is a situational type of depression, that I have to buckle down and plow through and it's all on me?
What if?
What if I'm changing pdocs because I basically didn't like what she had to say? Maybe changing pdocs won't help anything. Maybe the new one will say the same thing. Maybe I'm just chasing meds, looking for the easy way out.
I look back at myself over the last 3 years, trying to see patterns, trying to see what I'm doing right and what I could improve on. I'm trying to be open and bluntly honest with myself. I need to be if I'm going to get stable.
One thing Ive noticed (and I picked up on this about a year and a half ago) is that once I start to get better I'll be better for a couple of months and then relapse. I get depressed again. And a year and a half ago M (therapist) and I discussed this. We talked at length my "not wanting" to get better. We worked through it, we found and worked through a few triggers, and having me identify this flaw within myself had curbed that tendency to self sabotage.
And I look back and I see no self sabotage for my mania (and hospitalization) last November, no self sabotage for my suicidal depression (and hospitalization), last December, and no self sabotage for my suicidal depression (and hospitalization), last May. I find no trigger, no form of self sabotage - it just happened.
July and August this year I was starting to become more stable. In October I started to slide, by November I was down and getting worse, and December has been horrid. I know I had one trigger: a piece of Al-Anon literature I read on forgiveness. It gave me icky feels. I worked through these feels in Al-Anon, in therapy, and with my hubby. I worked through them. I laid them to rest.
Now, knowing that was a trigger, I was doing all the proper things to counter the emotional response. I talked about it, I journaled my feelings and thoughts, I countered my negative thoughts, I didn't catastrophize, I did everything right.
I worked through it. I felt better about it, and felt that I had nothing more to say on the matter.
Several weeks later is when I really started to spiral. I did all of my CBT stuff that I've learned about, I talked to hubby and in therapy. I didn't let myself isolate - I forced interaction. Again, doing everything right.
So what the hell is going on?? Did I have a PTSD trigger that threw me into a bipolar mood episode? Is this just PTSD? Is this just a bipolar shift with no real trigger? Does it really matter?
Because here in lies the rub: I'm doing all my CBT things, I'm trying to stay present, stay in the moment, take it day by day (sometimes moment by moment), counter my errors of thinking, not isolate, trying to "fake it till I make it" . . . all the things I should be doing.
But they're not helping.
They should be helping. If this was all me, all PTSD, all a trigger, then this shit should be working. And it's not. M pointed out that that one Sunday at work where I was crap and laid on the floor for 2 hours because I was suicidal and didn't know what else to do was most definitely not a trauma issue - it was most definitely a chemical imbalance issue.
If all my behavioral therapies are not working that would lead to a chemical problem, right? So meds, right?
But my pdoc won't prescribe me anything else because she believes this depression is all trauma, all in my head. That if I do more trauma work I'll be fine.
I don't even know what to talk about trauma wise anymore. I really don't. We've gone over my abusive relationship and rape. We've gone over my dad's death. We've gone over stuff with my (alcoholic) mom several times. I don't what else to say on these matters. I have no idea. I don't even know what to say in Al-Anon anymore (I've been silent the last three sessions cause I have nothing to add).
So what more trauma work do I need to do??
There's only one area I see where I need more work: fake it till I make it. I've been faltering in this area. Why? Because it's hard to pretend to be positive, to be okay, to be well, to be not depressed. It takes so much energy and it's so much easier to give into the depression. It's better for me to fake it, it is. But I've been so tired lately, the past few weeks, that it's gotten harder. It's easier to give in. To not fight. See, part of me wants to give up. I'm tired of fighting my moods everyday. I'm tired of the knowledge that I'll do this for the rest of my life. It's too much to handle and so I'm slacking on forcing myself to seem okay (even when - especially when) I'm completely broken on the inside.
What the fuck do I do? Change pdocs I guess, see what the new one has to offer. I don't know. I don't even know. This is all very frustrating as fuck.
Also? I've noticed that since I've been on 600mg of seroquel my cognition is suffering. I forget letters in words or add extra letters, it's taking longer for me to think things through, to respond. Joy.
Friday, December 19, 2014
And Then My Hope Went *poof*
That's exactly what my hope did.
*poof*
Gone. Lost somewhere in the stratosphere, floating around, uncatchable.
Or it's in the trash. I'm not sure at this point. (Floating around in the stratosphere sounds sexier though).
Why did my hope go *poof*? Well, I saw my psychiatrist, Mary, on Wednesday. And . . .
Wait. Let's back up a minute.
I want to recap what's been going on, in case you haven't read any previous posts. I'm depressed again. It's bad again. I have suicidal ideation on most days. I want to cut and I have. I alternate between wanting to die or wanting to not exist. It feels as though everything is being ripped from me again - I was starting to get stable over the summer and now everything is crashing down around me, hundreds of thousands of tiny shards and there's no way I can possibly pick them all up again. And every time I shatter like this, I miss a few pieces. Or a hundred pieces. Each time I break it's harder to collect those pieces, those shards, and this time they seem to be scattered further.
Okay. Back to Mary.
I sat in the waiting room doing a word search on my phone, feeling irritable and depressed. Surprisingly, I didn't have to wait long to be called back. Mary has a psychiatric nurse working with her who starts the intake - she gets my weight, blood pressure, and starts asking me questions. How are you doing? Bad. I'll go with that - the opposite of good. What's been going on? My depression is continuing to get worse. Five weeks ago Mary increased my seroquel and I haven't noticed any difference. I have suicidal thoughts more days than not. Do you have a plan? Yes. But I have no intent. Can you contract for safety? Sure. When was the last time you cut? This morning (I proceed to roll up my left sleeve). What's been going on the last few weeks? How's home? Work? Nothing has changed. Work is busy, home is fine. No triggers that neither I nor my therapist can identify. Any hallucinations? No.
She typed everything I was saying, went over my meds, and brought me back to Mary's office. I liked Mary when I saw her 5 weeks ago. I liked her more than Chika (she works with Mary and is who I've been seeing since June).
Mary is reading everything her nurse wrote about me. I sit down. She looks up at me over the rim of her glasses. Cami, right? Yes. Seems like you're not doing to well. Tell me about the suicidal thoughts. Um, well, I have ideation more days than not. I think mostly right now of slitting my wrists. Before it was always an overdose, but not now. I've had 3 days in the past 5 weeks that I probably should have gone to the hospital. But I'm stubborn and I didn't want to go - I wanted to try and manage it on my own. My therapist was a little mad at me because 1. I didn't go in, 2. I didn't call or email him (but he was in Italy on vacation and I didn't want to bother him), and 3. I didn't call you to let you know.
Before she asks another question I pull a piece of paper from my purse - the results of my genetic testing - and hand it to her. As far as my current meds go, my dosing is fine (the genetic testing was for medication metabolism - so, for example, if you're a high metabolizer for such and such a class, you'd need a lower dose of that drug).
Mary is looking at the results and to her computer screen. Results. Computer screen. Then she looks at me. You've been on a lot of meds. I know. She sighs. I don't think meds are going to help your depression. Look - you've been on so many and none of them has really helped, at least not more than a few weeks. Meds aren't going to help. I stare at her. The force of what she just said hits me hard and I'm speechless.
Wait. No.
Meds aren't going to work? You're telling me meds aren't going to work? (I think this, rather than say it).
She continues. Have you ever considered ECT? (I'm staring again). It can be very successful in treating depression. I haven't really thought about it for myself. Seriously, at least. It's just . . . the memory loss associated with it. Not such a good thing when you're a nurse. I'd have to be on leave for the entire duration of treatment (3-6 months). That's true. Have you heard about EMDR? Yes. You have a lot of trauma in your past, EMDR would be beneficial. I already do trauma work with my therapist. His specialty happens to be trauma. We're just moving at a snail's pace because it can be so triggering. My session last week was crisis intervention because of my depression. But we've been working on trauma. Okay, good. Have you heard of DBT? Dialectal behavioral therapy? There are group DBT sessions that you may want to look into. You learn coping skills and ways to manage your emotions. Okay . . . You could also look into neurofeedback. What's neurofeedback? You have electrodes placed on your head to measure your brain waves and then you learn how to change your brain wave pattern. Oh. Okay. Do you give me referral? How does that work?
I'm almost in a trance at this point. My head is reeling. I'm going into shutdown mode. Meds aren't going to help your depression. You don't understand Mary. I need meds to work for me. They have to work for me. I've been doing everything right. I'm trying my hardest. I'm fucking trying and I need a little help here!
She continues. You'll need to research groups nearby and contact your insurance company to see if they cover these treatments. Some companies do, most don't. You do need to work through your trauma. I think that will help. It complicates things. Okay. (I nod. I'm on the verge of tears. I'm trying desperately not to cry). She looks sternly at me. You know, sometimes people have this black cloud around them their whole lives and it never gets better. Maybe they have suicidal thoughts all the time and they're just there. It doesn't go away.
I'm staring again. I wouldn't doubt that my mouth dropped open a little bit. You're sitting here telling me that this won't get better. Meds won't work. Here are a few therapies you could try that may or may not help and that insurance probably won't cover but I'm trying to give you something to grasp for because let's face - nothing has worked before so probably nothing will work now, either. The same person telling me this told me 5 weeks ago that I didn't have to feel depressed - that we would find something that works and we can manage the depression better and don't give up because I'm hopeful that you'll get better soon.
This is not okay.
She must have read my face, my thoughts, my posture. Look, you should be proud of yourself! Look how far you've come! You're doing every possible thing you can do to get better. You're doing everything right. Okay. How about we try increasing the seroquel to 600mg? Maybe you just need more. Maybe your body needs a higher dose for the antidepressant effects. (I nod. I'm not hopeful. You told me meds won't work, yet we're going to increase a med that you don't think will work. Are you trying to placate me?) Okay. We'll try that for 4 weeks and I can even increase it to 800mg in 4 weeks if we want to try that. But we'll try 600mg for now. Look into DBT group and neurofeedback. And have a Merry Christmas! Okay.
I nod. I'm in disbelief. I make my way to the front desk and make my follow up appointment. The tears are threatening. I make it to my truck before I completely break down. I sat for 10-15 minutes sobbing. Uncontrollable sobbing full of pain and despair and frustration.
That was not what I was expecting from that appointment. Well, increasing the seroquel I expected. But not to be told that meds probably aren't going to work, aren't going to help, and we're kinda at the end of the line so maybe you should look into ECT because there really isn't much more out there for you. I was looking for hope, and I didn't get that. The thin strand of hope I'm desperately holding on to is unraveling.
And it fucking sucks.
I'm looking into DBT and neurofeedback. I'm going to discuss them with my therapist (I don't see a huge difference between DBT and what I've learned doing CBT with my therapist).
All I want is for something to work. I don't think that's too much to ask.
I've two docs tell me I need to sort through my trauma stuff and I have been. And even though I have been, I still can't identify triggers (I know some, and I can counter them so I don't have such a large emotional response, but I don't know most).
So I went up to 600mg of seroquel Wednesday night. Yesterday morning and this morning were hard to wake up to - for many weeks now I've been having a progressively harder time waking up simply because I don't want to be awake - but jumping from 400mg to 600mg seems to have made me more drowsy in the morning (hopefully that will go away).
The only thing I can do is to keep trying. At least my stubbornness comes in handy with this. My therapist had told me that as long as I'm breathing, there's hope.
I'd like to believe him.
*poof*
Gone. Lost somewhere in the stratosphere, floating around, uncatchable.
Or it's in the trash. I'm not sure at this point. (Floating around in the stratosphere sounds sexier though).
Why did my hope go *poof*? Well, I saw my psychiatrist, Mary, on Wednesday. And . . .
Wait. Let's back up a minute.
I want to recap what's been going on, in case you haven't read any previous posts. I'm depressed again. It's bad again. I have suicidal ideation on most days. I want to cut and I have. I alternate between wanting to die or wanting to not exist. It feels as though everything is being ripped from me again - I was starting to get stable over the summer and now everything is crashing down around me, hundreds of thousands of tiny shards and there's no way I can possibly pick them all up again. And every time I shatter like this, I miss a few pieces. Or a hundred pieces. Each time I break it's harder to collect those pieces, those shards, and this time they seem to be scattered further.
Okay. Back to Mary.
I sat in the waiting room doing a word search on my phone, feeling irritable and depressed. Surprisingly, I didn't have to wait long to be called back. Mary has a psychiatric nurse working with her who starts the intake - she gets my weight, blood pressure, and starts asking me questions. How are you doing? Bad. I'll go with that - the opposite of good. What's been going on? My depression is continuing to get worse. Five weeks ago Mary increased my seroquel and I haven't noticed any difference. I have suicidal thoughts more days than not. Do you have a plan? Yes. But I have no intent. Can you contract for safety? Sure. When was the last time you cut? This morning (I proceed to roll up my left sleeve). What's been going on the last few weeks? How's home? Work? Nothing has changed. Work is busy, home is fine. No triggers that neither I nor my therapist can identify. Any hallucinations? No.
She typed everything I was saying, went over my meds, and brought me back to Mary's office. I liked Mary when I saw her 5 weeks ago. I liked her more than Chika (she works with Mary and is who I've been seeing since June).
Mary is reading everything her nurse wrote about me. I sit down. She looks up at me over the rim of her glasses. Cami, right? Yes. Seems like you're not doing to well. Tell me about the suicidal thoughts. Um, well, I have ideation more days than not. I think mostly right now of slitting my wrists. Before it was always an overdose, but not now. I've had 3 days in the past 5 weeks that I probably should have gone to the hospital. But I'm stubborn and I didn't want to go - I wanted to try and manage it on my own. My therapist was a little mad at me because 1. I didn't go in, 2. I didn't call or email him (but he was in Italy on vacation and I didn't want to bother him), and 3. I didn't call you to let you know.
Before she asks another question I pull a piece of paper from my purse - the results of my genetic testing - and hand it to her. As far as my current meds go, my dosing is fine (the genetic testing was for medication metabolism - so, for example, if you're a high metabolizer for such and such a class, you'd need a lower dose of that drug).
Mary is looking at the results and to her computer screen. Results. Computer screen. Then she looks at me. You've been on a lot of meds. I know. She sighs. I don't think meds are going to help your depression. Look - you've been on so many and none of them has really helped, at least not more than a few weeks. Meds aren't going to help. I stare at her. The force of what she just said hits me hard and I'm speechless.
Wait. No.
Meds aren't going to work? You're telling me meds aren't going to work? (I think this, rather than say it).
She continues. Have you ever considered ECT? (I'm staring again). It can be very successful in treating depression. I haven't really thought about it for myself. Seriously, at least. It's just . . . the memory loss associated with it. Not such a good thing when you're a nurse. I'd have to be on leave for the entire duration of treatment (3-6 months). That's true. Have you heard about EMDR? Yes. You have a lot of trauma in your past, EMDR would be beneficial. I already do trauma work with my therapist. His specialty happens to be trauma. We're just moving at a snail's pace because it can be so triggering. My session last week was crisis intervention because of my depression. But we've been working on trauma. Okay, good. Have you heard of DBT? Dialectal behavioral therapy? There are group DBT sessions that you may want to look into. You learn coping skills and ways to manage your emotions. Okay . . . You could also look into neurofeedback. What's neurofeedback? You have electrodes placed on your head to measure your brain waves and then you learn how to change your brain wave pattern. Oh. Okay. Do you give me referral? How does that work?
I'm almost in a trance at this point. My head is reeling. I'm going into shutdown mode. Meds aren't going to help your depression. You don't understand Mary. I need meds to work for me. They have to work for me. I've been doing everything right. I'm trying my hardest. I'm fucking trying and I need a little help here!
She continues. You'll need to research groups nearby and contact your insurance company to see if they cover these treatments. Some companies do, most don't. You do need to work through your trauma. I think that will help. It complicates things. Okay. (I nod. I'm on the verge of tears. I'm trying desperately not to cry). She looks sternly at me. You know, sometimes people have this black cloud around them their whole lives and it never gets better. Maybe they have suicidal thoughts all the time and they're just there. It doesn't go away.
I'm staring again. I wouldn't doubt that my mouth dropped open a little bit. You're sitting here telling me that this won't get better. Meds won't work. Here are a few therapies you could try that may or may not help and that insurance probably won't cover but I'm trying to give you something to grasp for because let's face - nothing has worked before so probably nothing will work now, either. The same person telling me this told me 5 weeks ago that I didn't have to feel depressed - that we would find something that works and we can manage the depression better and don't give up because I'm hopeful that you'll get better soon.
This is not okay.
She must have read my face, my thoughts, my posture. Look, you should be proud of yourself! Look how far you've come! You're doing every possible thing you can do to get better. You're doing everything right. Okay. How about we try increasing the seroquel to 600mg? Maybe you just need more. Maybe your body needs a higher dose for the antidepressant effects. (I nod. I'm not hopeful. You told me meds won't work, yet we're going to increase a med that you don't think will work. Are you trying to placate me?) Okay. We'll try that for 4 weeks and I can even increase it to 800mg in 4 weeks if we want to try that. But we'll try 600mg for now. Look into DBT group and neurofeedback. And have a Merry Christmas! Okay.
I nod. I'm in disbelief. I make my way to the front desk and make my follow up appointment. The tears are threatening. I make it to my truck before I completely break down. I sat for 10-15 minutes sobbing. Uncontrollable sobbing full of pain and despair and frustration.
That was not what I was expecting from that appointment. Well, increasing the seroquel I expected. But not to be told that meds probably aren't going to work, aren't going to help, and we're kinda at the end of the line so maybe you should look into ECT because there really isn't much more out there for you. I was looking for hope, and I didn't get that. The thin strand of hope I'm desperately holding on to is unraveling.
And it fucking sucks.
I'm looking into DBT and neurofeedback. I'm going to discuss them with my therapist (I don't see a huge difference between DBT and what I've learned doing CBT with my therapist).
All I want is for something to work. I don't think that's too much to ask.
I've two docs tell me I need to sort through my trauma stuff and I have been. And even though I have been, I still can't identify triggers (I know some, and I can counter them so I don't have such a large emotional response, but I don't know most).
So I went up to 600mg of seroquel Wednesday night. Yesterday morning and this morning were hard to wake up to - for many weeks now I've been having a progressively harder time waking up simply because I don't want to be awake - but jumping from 400mg to 600mg seems to have made me more drowsy in the morning (hopefully that will go away).
The only thing I can do is to keep trying. At least my stubbornness comes in handy with this. My therapist had told me that as long as I'm breathing, there's hope.
I'd like to believe him.
Friday, September 5, 2014
Booooooooooo
I'm not sure if I've posted about this particular topic before. So I'm gonna give some background info first:
You all probably know that my mom is an alcoholic. Has been one for as long as I can remember. I have vivid, negative memories of my childhood, being the caretaker often for my brother and my mom. Lots of baggage with this. I'm ACOA (adult child of an alcoholic). This brings numerous characteristics of behavior and maladapted coping (which goes along awesomely with being bipolar . . . that was sarcasm by the way). (I should also point out that she is in complete denial about her drinking. She could be pouring vodka in a cup, drink from it, and tell you that she doesn't drink. I'm not exaggerating)
I've been diagnosed with chronic PTSD because of my upbringing. My mom is a huge trigger for me (my therapist and I have been working on this intensely for the last month and a half or so). For the longest time I refused to talk to her after about 6pm. Why? Because she would most likely be drunk and I can't handle that. Talking to my mom when she's been drinking - even if she's not drunk - has a decidedly negative effect on me. Anger, frustration, helplessness, fear, guilt, and shame all flood me. I overreact emotionally, which can send me into a bipolar mood swing. That's not good.
While trying to work through all this in therapy she's become even more of a trigger for me. So that even getting a text from her (no matter what time of day) gives me all of those negative emotions and fills me with anxiety. My therapist suggested I do something drastic - cut my mom out completely. No texts, no phone calls, no emails. If I don't have to constantly battle my negative feelings, perhaps I could work more on recovery. Makes sense.
And was very inviting.
So I sent my mom an email outlining the restrictions. No contact unless I initiate it. If she wanted to know how I was doing she could enquire through my hubby (which he had said he was okay with). I explained why. I let her know that this wasn't permanent, but that I didn't know how long it would last. She sent me an email back letting me know how much this hurt her (a guilt tactic, which she had used often growing up - I have no doubt that this decision hurt her but she lays it on thick). She said she would honor my wishes.
It was going well for a couple of weeks. I was a little more relaxed. I'm dealing with a lot of guilt over this as I'm her daughter - I should be talking to her and checking up on her and being what a daughter is supposed to be (which my therapist told me I need to get over - he pointed out that I felt this way partly because I always felt that way growing up - I had an obligation to her).
And then last night happened.
She texted my hubby and let him know that she had gone to the hospital as she thought she had a blood clot (she had surgery for a broken ankle 8? 10? 12? weeks ago and was in a cast and then a walking boot). She told him that she was home and okay and it wasn't a clot (whatever was going on was caused because she wasn't following her physician's orders and hadn't been wearing the walking boot like she was supposed to). She stated in her text that all she needed was me and that I wasn't there for her and it was bullshit (I read the text). All those icky, negative feels? They came flooding back. My sense of guilt and shame overwhelmed me. I didn't know what to do. I mean, she's my mom and I love her and I want to know that she's alright. But at the same time the thought of talking to her filled me with dread.
After much trepidation I decided to text her. Asked her how she was doing as hubby had told me about the trip to the hospital. It was a very brief exchange of texts. I told her if something major like this happened that she could contact me - I'm not heartless, I'm just trying to care for me and heal.
The exchange of texts, the feelings that flooded me . . . it was overwhelming. The hour of deliberation and texts left me completely exhausted. Literally. It was only 8pm and I was ready for bed I was so exhausted. How fucking stupid is that? And equally disturbing is that no one can really understand that.
How having to wrestle with my feelings and my mom can take everything out of me and leave me empty.
It is so. Fucking. Stupid.
I didn't tell my hubby that last night. I don't think he'd understand (sorry). And the not understanding coupled with the guilt and shame I was feeling would have really put me over the top. I was already fragile enough last night.
I fucking hate this.
Today I'm conflicted. I feel so guilty that I think I should just reinstate contact with my mom. Not because I want to - but because I feel obligated to do so. My therapist would very strongly advise against this (as does my best friend). I need to get myself healthy. I shouldn't engage with my mom until she's not such a strong trigger. I'm siding with no contact. I need time.
I just hate how shitty I feel.
You all probably know that my mom is an alcoholic. Has been one for as long as I can remember. I have vivid, negative memories of my childhood, being the caretaker often for my brother and my mom. Lots of baggage with this. I'm ACOA (adult child of an alcoholic). This brings numerous characteristics of behavior and maladapted coping (which goes along awesomely with being bipolar . . . that was sarcasm by the way). (I should also point out that she is in complete denial about her drinking. She could be pouring vodka in a cup, drink from it, and tell you that she doesn't drink. I'm not exaggerating)
I've been diagnosed with chronic PTSD because of my upbringing. My mom is a huge trigger for me (my therapist and I have been working on this intensely for the last month and a half or so). For the longest time I refused to talk to her after about 6pm. Why? Because she would most likely be drunk and I can't handle that. Talking to my mom when she's been drinking - even if she's not drunk - has a decidedly negative effect on me. Anger, frustration, helplessness, fear, guilt, and shame all flood me. I overreact emotionally, which can send me into a bipolar mood swing. That's not good.
While trying to work through all this in therapy she's become even more of a trigger for me. So that even getting a text from her (no matter what time of day) gives me all of those negative emotions and fills me with anxiety. My therapist suggested I do something drastic - cut my mom out completely. No texts, no phone calls, no emails. If I don't have to constantly battle my negative feelings, perhaps I could work more on recovery. Makes sense.
And was very inviting.
So I sent my mom an email outlining the restrictions. No contact unless I initiate it. If she wanted to know how I was doing she could enquire through my hubby (which he had said he was okay with). I explained why. I let her know that this wasn't permanent, but that I didn't know how long it would last. She sent me an email back letting me know how much this hurt her (a guilt tactic, which she had used often growing up - I have no doubt that this decision hurt her but she lays it on thick). She said she would honor my wishes.
It was going well for a couple of weeks. I was a little more relaxed. I'm dealing with a lot of guilt over this as I'm her daughter - I should be talking to her and checking up on her and being what a daughter is supposed to be (which my therapist told me I need to get over - he pointed out that I felt this way partly because I always felt that way growing up - I had an obligation to her).
And then last night happened.
She texted my hubby and let him know that she had gone to the hospital as she thought she had a blood clot (she had surgery for a broken ankle 8? 10? 12? weeks ago and was in a cast and then a walking boot). She told him that she was home and okay and it wasn't a clot (whatever was going on was caused because she wasn't following her physician's orders and hadn't been wearing the walking boot like she was supposed to). She stated in her text that all she needed was me and that I wasn't there for her and it was bullshit (I read the text). All those icky, negative feels? They came flooding back. My sense of guilt and shame overwhelmed me. I didn't know what to do. I mean, she's my mom and I love her and I want to know that she's alright. But at the same time the thought of talking to her filled me with dread.
After much trepidation I decided to text her. Asked her how she was doing as hubby had told me about the trip to the hospital. It was a very brief exchange of texts. I told her if something major like this happened that she could contact me - I'm not heartless, I'm just trying to care for me and heal.
The exchange of texts, the feelings that flooded me . . . it was overwhelming. The hour of deliberation and texts left me completely exhausted. Literally. It was only 8pm and I was ready for bed I was so exhausted. How fucking stupid is that? And equally disturbing is that no one can really understand that.
How having to wrestle with my feelings and my mom can take everything out of me and leave me empty.
It is so. Fucking. Stupid.
I didn't tell my hubby that last night. I don't think he'd understand (sorry). And the not understanding coupled with the guilt and shame I was feeling would have really put me over the top. I was already fragile enough last night.
I fucking hate this.
Today I'm conflicted. I feel so guilty that I think I should just reinstate contact with my mom. Not because I want to - but because I feel obligated to do so. My therapist would very strongly advise against this (as does my best friend). I need to get myself healthy. I shouldn't engage with my mom until she's not such a strong trigger. I'm siding with no contact. I need time.
I just hate how shitty I feel.
Thursday, June 26, 2014
I officially started trauma work
And it kinda sucks. And by "kinda sucks" I mean it's pretty awful and I'm not looking forward to this every week.
But it has to be done.
Today was my first full session of trauma work. It started with a brief recap of my past week and a half (which has been damn crappy with break downs, self harm, and tons of icky feels). Then M said, bluntly, "So let's talk about your childhood". I didn't know where to start. There's so much and it's overwhelming.
I started with my mom's fractured ankle. She fractured her ankle last Friday night falling down her stairs (I can only assume she had been drinking - she's done this before). I took her to the orthopedist yesterday and it turns out she needs surgery and can't drive for 6 weeks. Which means I'll be helping her around. Which means I have to have more interaction with her than I want to. Which raises my anxiety level and icky feels and makes me angry and uncomfortable.
I had a crap day yesterday. I only got one hour of sleep and I was in a foul mood. Then the above happened. I spent most of the afternoon crying uncontrollably. I wan't so badly to self harm. I had decided that anytime I feel like self harming I'd draw a butterfly on my arm instead. I ended up with 9 butterflies yesterday. I shredded 2 lawn chairs and threw them across the yard. I sat outside listening to music while it sprinkled on me (I was hoping for a downpour) trying to calm down, crying off and on.
And then something dawned on me. I started thinking that I was having a PTSD overreaction to something. Namely, having to help my mom out was putting me in the position of caretaker to her - the role I played growing up, taking care of her when she was drunk. Even though the situation for helping her out is different, emotionally I'm going back to when I was little. I'm dealing with childhood feels.
I told M this and he agreed that it was very probable that this is what was going on yesterday. It was a good segway into our discussion. Now, I'm not going to go into detail about what all was said. Not publicly. I'll probably write about it separately as I try to process everything.
One thing that did happen during therapy is that I emotionally shut down. I became guarded. I didn't want icky feels to flood me. This is something that I shouldn't do - I need to feel these things in order to process them, and I shut down. I'll be trying not to do that next week. I think I just had such a crappy week with feels and crying and such a horrible day yesterday with feels and crying that I couldn't take it today. So I shut down.
We spent our last 10-15 minutes talking about horses and horseback riding (I went riding last Saturday). It was a good way to decompress and try to release some of the icky feels.
This is hard, y'all. Trauma work sucks. I know it's necessary and that's fine - we'll muddle through as best we can. And hopefully I won't get thrown into a mood episode in the process.
But it has to be done.
Today was my first full session of trauma work. It started with a brief recap of my past week and a half (which has been damn crappy with break downs, self harm, and tons of icky feels). Then M said, bluntly, "So let's talk about your childhood". I didn't know where to start. There's so much and it's overwhelming.
I started with my mom's fractured ankle. She fractured her ankle last Friday night falling down her stairs (I can only assume she had been drinking - she's done this before). I took her to the orthopedist yesterday and it turns out she needs surgery and can't drive for 6 weeks. Which means I'll be helping her around. Which means I have to have more interaction with her than I want to. Which raises my anxiety level and icky feels and makes me angry and uncomfortable.
I had a crap day yesterday. I only got one hour of sleep and I was in a foul mood. Then the above happened. I spent most of the afternoon crying uncontrollably. I wan't so badly to self harm. I had decided that anytime I feel like self harming I'd draw a butterfly on my arm instead. I ended up with 9 butterflies yesterday. I shredded 2 lawn chairs and threw them across the yard. I sat outside listening to music while it sprinkled on me (I was hoping for a downpour) trying to calm down, crying off and on.
And then something dawned on me. I started thinking that I was having a PTSD overreaction to something. Namely, having to help my mom out was putting me in the position of caretaker to her - the role I played growing up, taking care of her when she was drunk. Even though the situation for helping her out is different, emotionally I'm going back to when I was little. I'm dealing with childhood feels.
I told M this and he agreed that it was very probable that this is what was going on yesterday. It was a good segway into our discussion. Now, I'm not going to go into detail about what all was said. Not publicly. I'll probably write about it separately as I try to process everything.
One thing that did happen during therapy is that I emotionally shut down. I became guarded. I didn't want icky feels to flood me. This is something that I shouldn't do - I need to feel these things in order to process them, and I shut down. I'll be trying not to do that next week. I think I just had such a crappy week with feels and crying and such a horrible day yesterday with feels and crying that I couldn't take it today. So I shut down.
We spent our last 10-15 minutes talking about horses and horseback riding (I went riding last Saturday). It was a good way to decompress and try to release some of the icky feels.
This is hard, y'all. Trauma work sucks. I know it's necessary and that's fine - we'll muddle through as best we can. And hopefully I won't get thrown into a mood episode in the process.
Tuesday, June 10, 2014
Back from Boston
And can I just say "wow". It was a whirlwind of a trip - we were only in Boston for around 24 hours. But I learned quite a bit - and can hopefully move forward in my recovery.
I'm still processing everything I was told, and probably will be for some time. A bomb of knowledge was dropped on me and, while some of it is just speculation, it's a lot for me to think about.
Let's start with this: I saw Dr. Brian Schulman at the Bipolar Clinic and Research Program at Mass General. I was sent to see him as a "second opinion". Basically, my psych doc (pdoc) has no idea what to do with me so he wanted me to see the big dogs - the guys who work only with bipolar patients. The appointment was 2 hours long and started with a thorough health and mental history (hubby was not in the office for most of the visit - only for about 30 min). He had me explain things about my past (my upbringing in an alcoholic home, my abusive ex, my father's death) in way more detail than anyone other than my therapist. He had me explain what my mania and depression were like, going over the big episodes and as many of the little ones as seemed relevant.
This lasted the first hour.
We spent only around 10-15 minutes going over meds - what I'm on currently (which he said is a good combo and he wouldn't change it) and what I've previously taken. My reaction to 2 meds (Latuda and Depakote) is highly unusual.
But we all knew that I was unusual.
And then the meat. Then he got to work. He pointed out that the most recent 2 diagnoses that I have been given (rapid cycling bipolar 2 and rapid cycling bipolar 1 with psychotic features) sent up a red flag. See, rapid cycling - true rapid cycling - is rare. (Rapid cycling is defined as having at least 4 distinct mood episodes in a year - each episode lasting at least 2 weeks). He said I didn't actually fit this criteria (while I've been told by my current pdoc, my new pdoc, my second opinion pdoc in Pueblo, and the docs at the hospital that I am rapid cycling). He said that since my hypomanic and mixed states (except for one in October/November 2013) don't typically last for more than a few days, they can't be considered a major mood episode. Hence, I'm not truly rapid cycling.
He told me that 9/10 times when someone comes to him with a "rapid cycling" diagnosis, something else is going on too.
My something else?
Chronic PTSD.
From my childhood. From being raised in an unpredictable, often unstable home with my mom. From my dad, who was my safety net, my confidant, and my strength, dying so young (he was 43 and died from lung cancer). From being in an abusive relationship. From being an RN (yeah - RNs actually build up chronic PTSD - we see some fucked up shit, y'all).
Dr. Schulman said that people with chronic PTSD react differently than say a war veteran with PTSD or a one time rape victim with PTSD. With the acute PTSD, you think of flashbacks, nightmares, all of that stuff. Not so with chronic. We don't adhere to the typical fight or flight - instead, we freeze. We either become numb, or we overreact emotionally.
Now, think about this. I have bipolar disorder. A mood disorder. Characterized by exaggerated moods. And chronic PTSD, in which I overreact emotionally. Let that sink in. I did.
Dr. Schulman explained that the 2 almost feed off each other and it's hard to tell which is which - which mood change that I have is from the bipolar and which is from the PTSD. He said that in the brief time he'd talked to me he saw only 2 "true" manic episodes (meaning they lasted 2 weeks or longer) - one in college and my one in October/November 2013 (this alone earns me a Bipolar 1 diagnosis). My hypomanic episodes (which can last hours to a day or two) could be bipolar mood shifts or PTSD overreactions. Or both - acting off one another.
So, in other words, it's complicated.
My medications, he explained, do an amazing job at warding off the big bipolar mood swings - the true mania and sometimes major depression - but do nothing for the little swings. Which is why changing medications all the time trying to manage these swings is ineffective (and mimics the unpredictable environment I was raised in, he pointed out, which can trigger more cycling).
We've been doing everything ass backwards it would seem.
So what helps these little swings? Psychotherapy. He said I had a lot of work to do in that area, in going over my past. Which, I know. We've spent so much time in therapy doing damage control and crisis intervention that we haven't spent much time delving into my past. I wouldn't even know where to start.
Now, there's the depressive side to this too, we can't forget that (especially since that's what I struggle with). I've had depression for as long as I can remember - 4th or 5th grade at least. And I always seem to have this underling depression, this black void in me that never goes away. Dr. Schulman believes that I also have Major Depressive Disorder - and that it's difficult to tell which depression is bipolar related, and which is depressive disorder related. So the depression is harder to treat. Most likely the constant underlying depression is depressive disorder and my more acute, suicidal depressions are bipolar related. But there's no way to know for sure.
Listening to all of this just kinda . . . clicked. It made sense to me. It seems very plausible. Dr. Schulman pointed out that some of this was speculation, based on the short amount of time we had to meet and talk, but that that was his professional opinion. Does that mean that this is a set-in-stone diagnosis/treatment plan? No. It most definitely isn't. This is another set of eyes taking a fresh look at my situation. This set of eyes just happens to be from a bipolar specialist. And what he said did make sense to me.
So I'm left with this - my diagnoses:
1. Bipolar 1
2. Major Depressive Disorder
3. Chronic PTSD
And work. I have a lot of work to do now. If Dr. Schulman is correct about my smaller swings, then it's all on me to manage them. And I've been doing a piss poor job at that because it's fucking hard, y'all. My mood swings, whether bipolar, PTSD related, or both, are unpredictable and difficult for me to manage - if it were easy, why the hell would I be going through everything I've been going through?
But hearing this, that all these little swings are most likely up to me to figure out and will probably never go away . . . that's fucking daunting. You kinda hold out hope that the right med combo will make it all better - and that's just not going to happen. He warned me that the weight of this would hit me - and might hit me hard. He even wanted to make sure I was seeing my therapist this week because of this. He told me to warn my hubby about it.
As I write this, I feel mostly numb. Mostly. Given the right trigger, I'd break down sobbing. I am so grateful that I had the opportunity to see Dr. Schulman. His opinion is by far the most different from any that I've received, but also the most comprehensive - it seems to take in the whole picture, whereas others are just about the meds.
At any rate, I have more of something that I've been lacking for awhile now. . .
Hope.
I'm still processing everything I was told, and probably will be for some time. A bomb of knowledge was dropped on me and, while some of it is just speculation, it's a lot for me to think about.
Let's start with this: I saw Dr. Brian Schulman at the Bipolar Clinic and Research Program at Mass General. I was sent to see him as a "second opinion". Basically, my psych doc (pdoc) has no idea what to do with me so he wanted me to see the big dogs - the guys who work only with bipolar patients. The appointment was 2 hours long and started with a thorough health and mental history (hubby was not in the office for most of the visit - only for about 30 min). He had me explain things about my past (my upbringing in an alcoholic home, my abusive ex, my father's death) in way more detail than anyone other than my therapist. He had me explain what my mania and depression were like, going over the big episodes and as many of the little ones as seemed relevant.
This lasted the first hour.
We spent only around 10-15 minutes going over meds - what I'm on currently (which he said is a good combo and he wouldn't change it) and what I've previously taken. My reaction to 2 meds (Latuda and Depakote) is highly unusual.
But we all knew that I was unusual.
And then the meat. Then he got to work. He pointed out that the most recent 2 diagnoses that I have been given (rapid cycling bipolar 2 and rapid cycling bipolar 1 with psychotic features) sent up a red flag. See, rapid cycling - true rapid cycling - is rare. (Rapid cycling is defined as having at least 4 distinct mood episodes in a year - each episode lasting at least 2 weeks). He said I didn't actually fit this criteria (while I've been told by my current pdoc, my new pdoc, my second opinion pdoc in Pueblo, and the docs at the hospital that I am rapid cycling). He said that since my hypomanic and mixed states (except for one in October/November 2013) don't typically last for more than a few days, they can't be considered a major mood episode. Hence, I'm not truly rapid cycling.
He told me that 9/10 times when someone comes to him with a "rapid cycling" diagnosis, something else is going on too.
My something else?
Chronic PTSD.
From my childhood. From being raised in an unpredictable, often unstable home with my mom. From my dad, who was my safety net, my confidant, and my strength, dying so young (he was 43 and died from lung cancer). From being in an abusive relationship. From being an RN (yeah - RNs actually build up chronic PTSD - we see some fucked up shit, y'all).
Dr. Schulman said that people with chronic PTSD react differently than say a war veteran with PTSD or a one time rape victim with PTSD. With the acute PTSD, you think of flashbacks, nightmares, all of that stuff. Not so with chronic. We don't adhere to the typical fight or flight - instead, we freeze. We either become numb, or we overreact emotionally.
Now, think about this. I have bipolar disorder. A mood disorder. Characterized by exaggerated moods. And chronic PTSD, in which I overreact emotionally. Let that sink in. I did.
Dr. Schulman explained that the 2 almost feed off each other and it's hard to tell which is which - which mood change that I have is from the bipolar and which is from the PTSD. He said that in the brief time he'd talked to me he saw only 2 "true" manic episodes (meaning they lasted 2 weeks or longer) - one in college and my one in October/November 2013 (this alone earns me a Bipolar 1 diagnosis). My hypomanic episodes (which can last hours to a day or two) could be bipolar mood shifts or PTSD overreactions. Or both - acting off one another.
So, in other words, it's complicated.
My medications, he explained, do an amazing job at warding off the big bipolar mood swings - the true mania and sometimes major depression - but do nothing for the little swings. Which is why changing medications all the time trying to manage these swings is ineffective (and mimics the unpredictable environment I was raised in, he pointed out, which can trigger more cycling).
We've been doing everything ass backwards it would seem.
So what helps these little swings? Psychotherapy. He said I had a lot of work to do in that area, in going over my past. Which, I know. We've spent so much time in therapy doing damage control and crisis intervention that we haven't spent much time delving into my past. I wouldn't even know where to start.
Now, there's the depressive side to this too, we can't forget that (especially since that's what I struggle with). I've had depression for as long as I can remember - 4th or 5th grade at least. And I always seem to have this underling depression, this black void in me that never goes away. Dr. Schulman believes that I also have Major Depressive Disorder - and that it's difficult to tell which depression is bipolar related, and which is depressive disorder related. So the depression is harder to treat. Most likely the constant underlying depression is depressive disorder and my more acute, suicidal depressions are bipolar related. But there's no way to know for sure.
Listening to all of this just kinda . . . clicked. It made sense to me. It seems very plausible. Dr. Schulman pointed out that some of this was speculation, based on the short amount of time we had to meet and talk, but that that was his professional opinion. Does that mean that this is a set-in-stone diagnosis/treatment plan? No. It most definitely isn't. This is another set of eyes taking a fresh look at my situation. This set of eyes just happens to be from a bipolar specialist. And what he said did make sense to me.
So I'm left with this - my diagnoses:
1. Bipolar 1
2. Major Depressive Disorder
3. Chronic PTSD
And work. I have a lot of work to do now. If Dr. Schulman is correct about my smaller swings, then it's all on me to manage them. And I've been doing a piss poor job at that because it's fucking hard, y'all. My mood swings, whether bipolar, PTSD related, or both, are unpredictable and difficult for me to manage - if it were easy, why the hell would I be going through everything I've been going through?
But hearing this, that all these little swings are most likely up to me to figure out and will probably never go away . . . that's fucking daunting. You kinda hold out hope that the right med combo will make it all better - and that's just not going to happen. He warned me that the weight of this would hit me - and might hit me hard. He even wanted to make sure I was seeing my therapist this week because of this. He told me to warn my hubby about it.
As I write this, I feel mostly numb. Mostly. Given the right trigger, I'd break down sobbing. I am so grateful that I had the opportunity to see Dr. Schulman. His opinion is by far the most different from any that I've received, but also the most comprehensive - it seems to take in the whole picture, whereas others are just about the meds.
At any rate, I have more of something that I've been lacking for awhile now. . .
Hope.
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