Took my first dose of Trileptal tonight, so Josh and i are on Side Effect Watch, although its supposed to be so similar to Tegretol that i can straight-swap it without the body even noticing anything's changed. Makes me wonder if my brain and body are going to turn out to be so different. Anyway, enough bitching about that, only time will tell.

So, here goes. The first day of the rest of my life, or just another spin on the medi-go-round?

     "Trileptal is not really a "new" medication.  It's just an old one, carbamazepine (Tegretol) with an oxygen stuck on it.  But fortunately this oxygen solves the biggest problem that kept carbamazepine a very distant third choice compared to lithium and Depakote -- the tendency to decrease white blood cells, which are your infection-fighting cells.  Since people don't "feel" their white blood cells, these could get dangerously low and leave a person vulnerable to infection.  Tegretol is still a reasonable choice.  It's still around as a choice because as generic carbamazepine it's quite a bit cheaper than Trileptal."

So this afternoon i headed out with Josh to my appointment with my new shrink. The appointment was for 2:15, and i'd been warned that a ton of paperwork was likely to need filling out, so i went in a few minutes early just in case. Josh made sure i was in ok, then went off to get gas and get the car washed.

So, i get in and im handed the obligatory slew of paperwork. After filling out the bits i knew, and worrying about the bits i didnt, i gave the paperwork back to be countersigned. At this point, i should say that this was the SCARIEST waiting room i have ever sat in. It smelt faintly of wee, there were about a million fishtanks and the walls were that "tacky swedish sauna" kind of fake wood. So, nervy and scared i sat back down. There were 3 other patients in the waiting room at this point. There was a really old guy who looked a bit like Leo from That 70's Show, and had an awful-sounding cough, there was a woman who was talking loudly about bras all the time to anyone who'd listen (and at one point, when someone's car alarm went off outside she shouted "well the car's horny, what about the driver?!") and there was a guy about my age with really red eyes who stared unblinkingly and quite hostile-ey at everyone. I didnt want to feel judgemental and "omg crazy people are scary" but when i get anxious i get PARANOID so it was pretty hard for me not to be scared. I went to sit in the corner and await my appointment. About 30 minutes after my appointment time i was called to the front desk; my doctor had seen an emergency patient earlier, as a result she was running late, was it ok if a different doctor saw me? At this point, just wanting to be seen and go, i agreed. So i sat. Starey-eyed guy left, then Loud Lady was seen, then Leo. Others came and went, i stopped looking and stared at the fishtank nearest me. By now it was over an hour past my appointment time, and i was getting antsy. I looked at my fingers and saw they (and my arm) were covered in blood. Apparently i'd been idly picking scabs off some healing SI scars and now they were all bloody, so i did my best to clean them up. I was literally twitching with anxiety by now, convinced i wasnt going to get seen at all that day. Well, finally i was called back to see the shrink, Dr S. He was a nice guy, had a very abrupt, distractable nature that i liked well enough but i know on an irritable day that guy would annoy the piss out of me. He asked me what i was taking, and when i told him carbamazepine he actually blinked in shock. He asked me to repeat for him, i was taking CARBAMAZEPINE? Uh-huh, i said. He blinked again, exhaled and then told me he hadnt written a script for carbamazepine since before the millennium. He went on to tell me that it is such an unpredictable drug most doctors dont even bother with it anymore, favouring newer anti-epileptics instead. I told him how it hasnt worked for me, all its done is taken away my euphoric manias and replaced them with dysphoric hypomania, mixed episodes and depression. Not my idea of a cup of tea. He asked me what i wanted to do, and i said i wanted OFF that drug, but i didnt mind staying on Seroquel, as i like being able to sleep.

So, we have a new game plan now. He's taking me off carbamazepine and replacing it, straight-swap stylee with Trileptal, which i've never heard of. And i'll be taking a higher dose of the Trileptal than i was of the carbamazepine. We may, or may not be also adding in Lamictal, he gave me the titration kit but said give it a week or so before i start it. He's upping my Seroquel to 100mg at night, and given me a sample of Saphris (another antipsychotic) to try in the instance of intrusive thoughts/ psychotic epidsodes. Im unsure as to whether or not he wants to eventually replace Seroquel with Saprhis or not, he wasnt exactly clear. Oh, and just like every new psych he wants about a million blood tests etc done.

So, there we go... my first visit to an American psychiatrist. I'll keep you posted on the new game plan, and how it works/ doesnt work etc.

First i'd like to acknowledge just how hypocritical this entry is going to sound, given that im writing it on a blog that i choose to write, specifically about my issues with my mental health. Yes, im a hypocrite sometimes. It's my blog anyway, so nuh.

Second i'd like to apologise. I havent had an awful lot of sleep the past couple of days, and i took trazodone a few hours ago, all of which means that im writing this in a strange video game-like haze (and a blanket that smells like old farts, come to mention it...). 

So Josh started with his new squadron last week, and amongst other things he had a meeting with his supervisor. I knew it was coming, and i resigned myself just to cringe in embarrassment. You see, after last year's events (the whole psych ward thing, how much time Josh had to take off just to make sure i didnt kill myself/ get me to appointments on time etc etc) we discovered that being open and honest with those both of us work with (eventually when i get a job again, or even for school etc) is much more beneficial than covering things up. For one, you dont look like a serial slacker, or worse an outright liar. Another reason is that sometimes help and support is available that you might not have known was there otherwise.

Truth be told, Josh and i got through last year because we know some amazing people. Close friends of ours who helped out ferrying me around when Josh wasnt able to, and offered moral support and help during difficult times, people he worked for and with being lenient about the time he had to take off (including him being granted emergency leave without even asking for it the day after i discharged myself from hospital!), the whole works. Without all those people (they know exactly who they are, and i dont have their permission to use their names here, which is why i havent named names!) it would have been a different story entirely. 

So now i go back to Josh's meeting with his new supervisor. We had talked about it, and agreed that the best possible course of action was for Josh to be open, and tell his supervisor about my illness. He may, at some point, need to leave work early to take me to appointments, i may end up in hospital again, anything could happen and as such we decided that it was just better to be upfront. But still, it made me cringe. Despite this blog, i dont exactly introduce myself as "My name's Gemma, and im a manic depressive". My close friends know, and occasionally it will come up in conversation, but for the most part i dont talk about my illness in general company. Which is why, although i understand why it was necessary to make this new supervisor aware of mine and subsequently Josh's personal circumstances, i find it so embarrasing that i dont know this guy from Adam and yet he knows about me. I could bump into him on the street and would not know it was him, and yet he knows about me. Not that he'd know it *was* me, but you get my drift. Hence the hypocrisy, because there are plenty (maybe) who read this blog who know nothing about me BUT my illness, and yet that doesnt bother me. I suppose because my husband doesnt have to work with those people. He doesnt have to be judged potentially by those people, because of my illness and my actions.

I think that's the crux of it, really... whether it's me or him telling a supervisor in a new workplace, its the instant judgement. Will they now think he's likely to be trouble, always wanting time off, because he's warned them that sometimes he may have to ask for time off because of me? Would an otherwise innocent leave request now be regarded suspiciously, wondering why he needs the time off etc etc. And for me, because my diagnosis is official i legally have to tell a potential employer that im ill. And from there, where can they go? Will they look at me and wonder if im worth the trouble, try to guage my current level of "madness", to see if im up to the job.

Sitting here tonight, at 02:00, unable to sleep and trying to avoid other invasive thoughts (too embarrasing to post here, sorry!), i think back to my last "serious" job, working for a contract company as a secretary. I had one more job after that, which only lasted 3 weeks, so i dont count that as "serious". When i started at the contract company i had previously been "let go" from a job selling water coolers. The managers had been as lenient as they could be, but my nonexistent sales figures coupled with my appalling sick record meant that they finally had to terminate my job. I was desperate, depressed and frightened. I took the first job i could find, which happened to be the secretarial job. If im honest, i lied from day 1 to get that job. I made myself sound peppy and upbeat, when my mood was pretty low and getting lower. At the beginning of the job i actually felt a bit better, learning new stuff took the edge off my symptoms. But the paranoia was intense, i believed the girl training me hated me (she may well have, i'll never know) and that everyone there was talking behind my back. As the weeks crawled on, my depression deepened and soon i was taking time off left, right and centre again. I didnt realise how much until it all fell apart and i found myself on the recieving end of a face-melting rant from my then boss, who informed me that in almost 4 months i had yet to work a full week. I broke down in his office and, sobbing so hard he had to strain to understand me, showed him the cuts on my arms. Told him how every day i walked to work crying and some days just didnt have the strength to do it at all. Told him how i often sat awake at 5 am contemplating suicide. Stunned he sent me home to think, but told me then and there that if i didnt think i was up to the job, he would give me the option to quit rather than be fired, on the condition that i did not try to seek employment for a while. I was to "sort my head out" first. The next day i returned, and gave him my notice. I was lucky. This guy was a bastard sometimes, but he was good enough to give me that final thing, allowing me to leave on my own terms, rather than be fired from another job.  

I wonder, if i had known about my diagnosis, and told him about it would things have been different? Would he have hired me? Would i, assuming i was medicated, have been able to handle the job after all? Now im contemplating returning to work this year, these are the things that are in my mind. And having to tell your potential employer that you went crazy and havent worked for 2 years is only the tip of the iceberg...

I have another entry im trying to write, about moving overseas, but it is proving harder to write than i thought. In the meantime, i wanted to write about this article:

http://www.furiousseasons.com/archives/2010/01/antipsychotic_use_doubles_in_americas_toddlers.html

"The most commonly-prescribed antipsychotic for toddlers is Risperdal"

RISPERDAL?! Are you fucking serious?! Maybe this scares me because Risperdal fucked me up so badly i wound up in a psych ward, but even without that, it is an extremely potent drug. It slows you down, messes with your moods and memory, makes you feel like your brain is dying. And they're giving this to TODDLERS?!

I was prescribed this for psychotic mania, so its hard for me to imagine what on Earth could be so very wrong with a TWO YEAR OLD that they would need such an extreme drug in their systems. I wonder what is wrong with parents today that they would rather allow their child to be drugged up than allow them to be a child.

Psychotic symptoms in an adult, potentially requiring an antipsychotic to treat them, include:

Hallucinations (seeing things that arent there)- NORMAL for a child

Auditory hallucinations (hearing things that arent there)- NORMAL for a child

Delusions- believing something or some situation to be true when it is not- NORMAL for a child

So basically giving a child this kind of medication is to not allow them to be a child. That literally makes no sense to me. I understand that in some cases there are children who may be extremely poorly and might need to be medicated, but one would think that these cases would be extremely rare, few and far between and not something that would be increasing. It makes me wonder if people these days are so brainwashed by the current culture of "if your kid acts even remotely like a kid they might be mentally ill/ have adhd etc" that they dont even realize that having an imagination is a normal thing for a kid. Its terrifying to think where this kind of thing is going to lead...

Im not having the best time right now. Im going to be blunt, im shitting razor blades. After a few weeks of high-normal mixed with hypomania, then a week of solid hypomania, this week it seems to be the one where my control is slipping. Mania is coming up on me and its starting to scare me. 

Its not the nice kind of mania, the happy-go-lucky, everythings awesome and i have a million good ideas kind of mania. Its what's known as dysphoric mania, literally the opposite of the stereotypical euphoric mania. I dont have these very often, but when i do its hell. Its either that or im slipping into some kind of crazy mixed episode (please, please, NO!). 

Dysphoric mania is unpleasant, to put it mildly. Imagine feeling like shit about yourself, your life and everything, thinking everyone is out to get you, having paranoid thoughts and delusions, but having all the crazy energy that comes with mania. Im super irritable, snapping at Josh over the slightest thing and the paranoia is starting to get out of control. Two nights ago i lay awake for hours (even with the seroquel) because i could hear someone (wearing heavy boots, no less!) pacing around outside our bedroom door. I couldnt even move to alert Josh because i knew beyond a shadow of a doubt that if i made a sound he/ she/ it was going to come into our bedroom and kill us. Last night i took a double dose of seroquel just because i wanted to sleep, and not have the insane paranoia again. So today im fuzzy and out of it, and really not feeling good at all.

Poor Josh copped it earlier because he was messing about, dancing about whenever i turned to my laptop (so i could just see out of my peripheral vision), then stopping every time i turned back to him. I asked him what he was doing and he said "nothing", so i went back to my laptop, and he started dancing. I asked him if he was dancing and he smiled and said no. He was mildly surprised when i started to cry and loudly reminded him he was messing with a woman who sees things that sometimes arent there. I then yelled at him to tell me once and for all, WHAT WAS HE DOING?! He apologised and said yes, he was dancing, but now he feels like a jerk because of what i said.

We are not easy people to live with, thats for sure.

Anyway, i wanted this to be a real account of bipolar disorder, and it doesnt get any more real than this, folks.

The last few days i've been pretty hyper. At the risk of sounding weird, i can literally *feel * the mania churning about underneath all the medication, desperate to get out. And i can feel the medication holding back what at times feels like a wave of "crazy", like a dam just waiting to break. And the worst thing is, how often i would like it to break, to let go and let it all out, just to get it out of my system!

In addition to this, my skin has gone haywire, which might not sound like much but only a few weeks ago i was thinking to myself "i may be overweight, and my hair may be falling out from the medications, but at least i have clear skin". I guess i spoke too soon. Which means that the old demons are chattering paranoically into my ear again, making it harder to see, hear or think straight. I dont feel i have many redeeming features right now lol. I dont know if its caused by my medications or not, but its very easy to put the blame there right now! In reality, though, its more likely to be the PCOS causing it. Either way, grrrrrrr! Not something i need!

Mostly, though, im just talking too much, thinking too much and all the usual fun times that come along with this diagnosis. And im a little irritable, coming up with ideas for stuff that doesnt really matter given that we're moving house in less than a month and all that good shit.

Still, seeing Dr M next week, so that might help or he might just tell me to take more drugs. Not that it really matters because its the last time i will ever see him again... im happy about that because he is almost impossible to get an appointment with, never returns phone calls (great considering sometimes you actually NEED to talk to your psychiatrist on the same day, not in 3 weeks time, after calling his office 4 times every day!!), never does things he promises to do and works at a hospital that's miles away. Not his fault, he's the only psychiatrist in East Anglia that currently accepts Tricare. 

Im also not so happy about finishing with him because he is a very nice guy, he and i work well because he doesnt sugar-coat things, or try to baffle me with bullshit, he just tells me like it is. Without him i would not have an accurate diagnosis or any medication and i would probably be dead by now. Or sectioned. 

Plus, im scared of the unknown. What happens in Omaha? Do i get a new shrink, and if so will they be as cool as him? Or will they try to re-diagnose me/ mess with my meds etc etc. Who knows....

Tonight i spent the evening with a friend and her baby daughter... i had a great evening, but something hit me hard. Seeing her with her child, they have such a lovely close relationship. So much love between them, and i realised this is a relationship i will likely never have. Between carbamazepine and its propensity for birth defects, the fact that coming off meds for the duration of conception and pregnancy would likely result in me going crazy and ending up hospitalized and the fact that i would likely pass the bipolar on to my child... having kids isnt looking like an option for me.

Adoption is something we have talked about, but still there are things to think about. What if Josh is deployed and i go crazy again, and end up in hospital? What happens to that poor kid? Plus, would adoption agencies consider a couple where the husband is in the forces and the wife is mentally ill?

Im ok about it most of the time... just nights like tonight when i see how happy and fulfilled others are by having kids that part of me aches again, almost like a phantom limb. 

I dunno... i think im just having one of those nights where i want to have a family so bad it almost hurts.

Seroquel (quetiapine) is an antipsychotic/ psychotropic agent used in the treatment of both Bipolar Disorder and Schizophrenia. Im sure it's used off-label for other stuff too. But anyway. I have a true, bona fide love/ hate relationship with this drug.

When Dr M first handed me the prescription, i was wary. I knew he was eager to replace my old antipsychotic (risperidone), which had been responsible for me ending up on a psychiatric ward for 4 days, but i was not so eager. My terrifying experiences on risperidone had kinda turned me off antipsychotic medication and i was quite happy the way i was (well, i *was* manic!). Dr M, however, had other plans. He didnt like running me as high as i was, and he was determined to bring my manias back down to normality again, so he upped my carbamazepine and put me on quetiapine at night.

I took the recommended 50mg dose, one in the morning and one in the evening, the next day. I was on my ass by 8:30pm, barely able to hold my eyes open. For the first time in, well EVER, that night i actually slept. I had managed sleep before, by taking Ambien or Lunesta, or by drinking vast amounts of alcohol, and during depressive episodes i slept pretty well, but erratically and usually during the day. Going to bed at a normal hour, going to sleep on time and being able to get up during the night to pee or whatever, and actually GO BACK TO SLEEP, well that was huge. Bigger than huge. I nearly cried with relief the next day.

I was soon to learn, however, that Seroquel has its dark side. It builds up in the system so that those first, refreshing, few days were soon a thing of the past. During my next depressive episode i learned that i couldnt take Seroquel in the mornings any more lest i spent the whole day staring at a wall. Despite being a little manic now, i still havent been able to go back to taking it in the mornings, because it leaves me feeling drugged and sleepy when i get up. Give me a couple of hours, about a gallon of coffee or diet coke and a bath or shower and im usually functioning pretty well, and the thought of adding to that drugged feeling just makes me feel ill. I do take it if i feel im going too high (or lets be honest here, if Josh thinks im going too high and tells me!), but not often. And that's just 25mg a day! I shudder to think what it does to people who take like 400mg a day!

You cant drink on Seroquel because it can do some nasty shit to your body, your liver in particular. Not even one glass of wine. So, if i have a drink, i cant take that evening's dose. Sadly this means i'd better not have just had one glass, i'd better be paralytic, because otherwise i wont sleep at all! 

So, rather like Bipolar Disorder itself, Seroquel has its up's and downs... overall, though, i like it. It's not a sleeping pill, so all it does is make me drowsy enough to sleep, and it almost simulates for me what it would be like to go to sleep normally, and that's got to be a blessing. Even if i am bumping into walls the next day...

I got to thinking the other day about how although most people who read this blog already know me in real life, there are a few who dont. Those who dont know me in person actually know more about my experiences with bipolar disorder than they do about me, so i decided to take the time to remedy that today...

So, here goes: a collection of random facts about the Girl Behind the Blog!

My name is Gemma, im 27 years old. I spent the first 20 years of my life in a small town called Orpington, which is in the South-East of England. Although i spent the longest portion of my life there, i dont consider it to be my "home town" as such, because a few years after moving away from Orpington i moved to the Isle of Thanet and fell in geographical love. The Isle of Thanet, and Westgate-on-Sea in particular, will always be my "home town".

By nature im a very stubborn person. I love cats and photography, i have an irrational phobia of moths and butterflies and i'll probably die of exposure before i admit its cold and put on a coat. Im a certified chocoholic and i find it hard to settle on anything. I like most kinds of music, and i tend to prefer songs to bands. Two of my favourite books are "The Handmaid's Tale" by Margaret Atwood, and "Girlfriend in a Coma" by Douglas Coupland. I like books that get me thinking, even though there are some that frighten me just a little!

On the subject of frightening myself, im good at that! I love watching scary videos or TV shows and then spending the whole night awake with the lights on, although i dont think Josh is particularly fond of that particular hobby... I love Dr Who and House, and up until they released Universe i was a huge Stargate fan. I still am, but i refuse point blank to watch Universe!

I used to be a qualified Holistic Therapist, and once believed that this was where i wanted my life to go... i learned fairly quickly that im not cut out for a life spent massaging people! It was fun to learn, and the experiences i had during my studies are still among some of my best memories but ultimately, although im glad i did it, i dont think its the career for me. 

I change my career plans on a regular basis, usually in accordance with any mood changes, so right now i have no idea what i'd like to do with my life. Im considering psychology or psychiatry (for obvious reasons) but im trying to really think it out, something i have never really done before!

Anyway, thats enough about me for now... Just wanted to write an entry that wasnt solely about the bipolar for once.