Tuesday, May 13, 2008

What To Do About This Pesky Diagnosis

In the nearly three years since I stopped taking most of my psych meds I've been trying to come to terms with the bipolar diagnosis I've been handed and figure out what it is I really need to do about it. The way I see it, there are a number of options...

1. Embrace the current paradigm of mental illness and take the damn meds. Been there, done that, and discovered that psychiatry has little to offer me besides a chemical cage, which I'm not particularly enamored with, thanks ever so. Mood stabilizers did not seem to stop my mood swings, and antidepressants reduced the time between episodes to months rather than years.

2. Deny the diagnosis--it was all a Big Mistake. But then I have to take full personal responsibility for my actions during the Big Mania, and that would make me a Horrible Person. And since I cringe and shudder in retrospect, I have a feeling I'm not a Horrible Person. Not really.

3. Ignore the diagnosis and go along my merry way. Except that it isn't just me I have to think about. I have a husband and kids, and if I go off the rails again, it's not just me that will suffer. So that seems a bit irresponsible.

4. Accept the diagnosis, but reject the current paradigm of mental illness, and do all I can to preserve stability. This is a lot of work, because it involves a lot of self-monitoring, self-awareness, and Being Honest with Myself. It also involves being able to say, "Okay, this isn't working, maybe I do need meds on a short-term basis." But if it keeps me off medication, then the work is definitely worth it.

And the fifth and only acceptable alternative, which both Gianna (Psychiatric Drug Withdrawal and Recovery) and Susan (Bipolar Wellness Writer) pointed out in their comments on yesterday's post, the reading of which helped me to finally be able to articulate:

5. Accept that I did once fit the criteria for a bipolar diagnosis, but that I have healed myself and that the diagnosis no longer fits. Of course, my doctor will not agree with this assessment. He will tell me that I'm a train wreck waiting to happen. He would, after all, like to get me hooked on his pet drug, Abilify.

In the spirit of continuing my healing journey, I am starting a more focused writing program, something that will help me examine specific issues rather than just my usual Daily Bitch session. I'm planning to use Julia Cameron's "Vein of Gold", and Deena Metzger's "Writing for Your Life."

It's cheaper than therapy, at any rate, and in my experience, writing is a very powerful healing tool.


Chris said...

I'm currently on #4. So far, so good. However, in the darkest times, I wonder if it's enough. I wish you luck.

Bipolar Wellness Writer said...

Great post! The question is: What other options do you have? You can try Abilify, but it's success rate as a mood stabilizer (as far as I know)is only anecdotal. Maybe your doctor has studies that prove otherwise; I haven't checked recently.

My question is: If you're beginning to get manic, can't you feel it coming on? If you can't, can your husband see signs? And if you're beginning a mania, can't you begin medication then--to end it?

While neither Depakote, Tegretol, Lithium, Lacmital, or Ability worked as a mood stabilizer for me, I can slow down a hypomania by using Ativan (which, I use as a sleeping pill when I need it).

I also have a lot of non-medication "tricks" for doing this.


Jazz said...

Thank you. And good luck to you, too. Only time will tell if it's enough...for both of us. But I'm trying to look at it in terms of not being willing to sacrifice all the time between episodes to medication, and dealing with episodes as they arise.

Jazz said...

In answer to your question--my last big episode was what led to my diagnosis...once I was actually on medication, it got worse--I had two depressive episodes and one mild hypomanic episode on the meds. But since getting off medication, I've had no episodes, so although I am now much more aware of what has been going on with me all my life, I've not had a chance to try out my new awareness and see how well my tools work for actually heading off an episode.

The thing about my manias is that they start very slowly and build over an extended period. My last one lasted 18 months before becoming unmanageable. The first 17 months were great--a very productive, creative, happy time. So I'm not sure how easy it will be to tell.

Like you said, I'm planning to use Ativan for heading off hypomania--if I detect it happening. I hate the way it makes me feel, but I suspect it would be quite effective for that purpose. That's the main reason I'm staying in contact with my current psychiatrist.

As far as heading off depression goes, I don't know if that's possible. Antidepressants didn't help me at all with depression, although they were good for anxiety. My depressions, though horrible, have never been actively suicidal, so I'm not too worried about it. I'll ride it out as I always have done.

Gianna said...

Hi Jazz,
Just want to caution you that if Ativan is used more than two weeks in a row it's one of the nastiest addictive drugs out there (any benzo is). I would personally use it only on an intermittent PRN basis...

I know it's very hard to figure this stuff out. Maybe I'm in denial, but I just don't believe I'll need to use "big guns" again.

Jazz said...

I feel the same way, Gianna, I'm thinking I'm not going to need the big guns again...I feel better keeping the Ativan around, but after reading about your experiences, and Stephany's problems coming off of Xanax, believe me, I will use it extremely cautiously. But I guess it's only responsible to give it some thought--how would I handle it? Stress management, yoga, meditation, as a first line of defense. Short term meds, if those things don't help. But which ones? They all seem nasty--nasty side effects and nasty withdrawals. And I certainly can't trust my doctor to give me good information about that.