The Psychiatric Medication Dilemma and Rapid Cycling Bipolar 2
TRIGGER WARNING - SUICIDAL IDEATION
This is going to be one of the hardest blogs I have written so far. There are times when words on paper diminish an event or subject matter. In my opinion, this is one of those times.
Due to my psychiatric disorders, I have been on and off psychiatric meds for the majority of my adult life. I do not wish to have this become a discussion on the topic of pill shaming or whether or not psychiatric medication is good, bad or indifferent. I believe that each of us with a mental disorder has the option and choice to use or not use these medications to enable us to have relief from our symptoms and lead as normal a life as possible. I respect those that choose not to use them, as that is their personal decision.
In my journey with mental illness, I have encountered others who are suffering from disorders that are on as many as 16 to 20 different medications at one time. There is a cycle, which exists whereby, in my opinion, psychiatrists resort to prescribing a certain medication and then add another medicine to offset that medication and its side effects. Then they add another to offset the side effects of that one and it becomes an absolute jambalaya of taking three antidepressants, four mood stabilizers and a partridge in a pear tree.
When starting a new medication they always tell us to “give it time to work”. It is a known fact that you just don't take one antidepressant and cure depression in a day. It can take time for these medications to work on the brain in order for us to see the outcome of a particular medication. It can usually take one to two months to get enough into your system, creating a period of waiting in hopes that this could be the Holy Grail fix to my disorder.
Typically, when starting out with psychiatric meds, most psychiatrists will take a conservative approach and start with the least intrusive medication for the condition. There are some however, who are prescription pad happy and will use an atomic bomb to kill an ant. I have experienced both types of psychiatrists. I tend to favor the conservative approach.
When you do not know what these medications are like and this is new to you, I am going to teach you something. Get educated very fast.
The other thing I am going to suggest is to have an advocate who loves and knows you very well like a spouse, parent or child, who might be able to recognize and see medication effects in you that you may not even see in yourself. They will also need to educate themselves on the different classes of meds and such.
When a particular medication has been in your system for a longer period of time, say three to five years, it can lose its effectiveness to treat you as you become immune to it. Being in your system so long, you build up a tolerance to it necessitating the time to change medications. This is where the fun begins. First of all, there's the issue of choosing the new medication and the different options and routes you can take. Then there is what they call the titration, which is a general and gradual decreasing of the obsolescent medication in your system taking it from let's say 200 mg down to 50 and then off of it completely over a course of time. The other times titration may be necessary is when you go on a new medication and realize that it is not working well with your system and therefore you must withdraw from it slowly.
Pretend I am screaming in your face right now, you do not just quit a psychiatric medication. You do not just go off it. People can die from doing that and it can be such a shock to your system that you can end up in a nice psych ward.
While I'm at it, I'm going to continue screaming at you for a minute... most of the medications that we take are very strong. Those of us who suffer from psychiatric disorders take medications that contain warnings that say….do not use alcohol with these drugs. I am still screaming. Have you seen the suicides of the famous actors, actresses and musicians that do use alcohol, psychiatric medications, recreational medications, and sleeping pills? It may not even have been an actual suicide attempt but rather the mixing of potent concoctions that killed them. I don't have to name names, watch the news. There are also those that are not famous, they are regular people like you and I, that have accidently killed themselves in the process of using alcohol and or recreational drugs in addition to their psychiatric medication. It is a very dangerous thing to do. Okay, I’ll stop screaming now and will get back on topic.
One of the other fun things that can transpire when titrating off a medication is that a trigger in the brain can happen. This is especially the case when mixing different types of medication and titrating off one, thereby leaving too much or not enough of the other medication in your system.
This happened to me a month ago. I had to titrate off a medication that was no longer working for me because I have been on it for 4 or 5 years. I was no longer getting any benefit from it and it was time to change up. I didn't think much of it because I have been through this so many times and kind of know what to expect.
I began titration a month ago from 200 mg on a drug, keeping all other levels of the other drugs I was taking the same. Nothing else changed. The day I arrived at 50 mg on my titration, all hell broke loose. I woke up and I just didn't feel right at all. The day began with hysterical crying, which switched to depression, then going straight into a full out attack of rage, before coming down into feeling kinda normal, then happy, then having a severe Panic Anxiety attack. Houston we have problems! My husband watched in horror as I flipped from mood to mood without any stabilization in sight. We were both confounded and completely confused. Immediately we put a call in to my psychiatrist.
The panic attacks and anxiety were so bad I was convinced I was going to have a heart attack and die. My blood pressure and pulse would go through the roof. The rage attacks were like the Incredible Hulk took over my body and we'll just leave it at that. By the end of the day, I was so exhausted from this emotional roller coaster and shape shifting, that I’d just fall into bed in hopes that the next day would render itself fixed.
Definitely not the case whatsoever! This journey lasted for two straight weeks. What we have found out from this episode is that in addition to BPD, Panic Anxiety Disorder, PTSD, OCD, and depression, I also have a condition called Bipolar 2. It's actually a hybrid called Rapid Cycling Bipolar 2. Unlike Bipolar 1, where you experience severe bouts of mania, crash and then go into what they call manic depression... this is completely different from Bipolar 1. Stars like Carrie Fisher and Patty Duke brought much light to this during their lifetimes and I thank them for that. This new fun little guy of Bipolar 2 Rapid Cycling never reaches full-blown Mania, instead it creates a state called Hypo-mania and in addition, you go through these cycles of moods.
Therefore, I start my research. Unable to sleep, I try to figure this out being up until 2, 3 a.m. in the morning. Below is a quote from one of the articles I researched. It is a testimony of what Rapid Cycling feels like. I found it on the International Bipolar Foundation website. Here is a copy to the link of the article: ibpf.org/article/3-stories-rapid-cycling
“Melanie: For me, rapid cycling is when I experience multiple “highs” and “lows” in a day. I am an extreme rapid cycler and I have several mood shifts throughout the course of a day. It’s really hard to handle, and it’s exhausting, as someone who works full time in an office setting. It doesn’t change minute to minute, but it sure feels that way! It really affects my energy levels and how I interact or want to interact with other people.
Rapid cycling feels like your mind is playing tricks on you. You are sad one minute, hyper the next, giddy, and then back to sad, teary, and wanting to hide. It’s very confusing and it’s scary how fast your mood can change and change and change. You feel like your moods are changing so quickly and you don’t know when you will feel “right” again. It is one of the most frustrating parts of having bipolar disorder.
I become frustrated with how emotionally labile I am, and I feel terrible that I have anger outbursts, am agitated and rude when I am in a hypomanic state, or that I am “useless” and unmotivated when in a depressed state, i.e. unable to cook, clean, empty the dishwasher, put things away etc.”
What is also confusing and frustrating about rapid cycling is that you can be anxious regardless of what state you are in. Or at least, that’s what happens to me.”
After researching this, my husband and I immediately scheduled again to meet with my psychiatrist. We also met with my therapist. In conclusion, I had to accept the diagnosis of Bipolar 2 reluctantly, but I also needed to accept the hybrid of the Rapid Cycling. I learned in my research that a triggering of Rapid Cycling in your brain might last from 4 days to 6 months. Borderline Personality Disorder and Bipolar, whether it's Bipolar 1 or 2, are called sister disorders. I therefore learned its common for somebody with BPD also to have Bipolar and vice a versa. They kind of hide and blend into each other so that many times one can go undiagnosed while the other plays out. This means a person treated for one disorder can be excluded treatment from the other, due to a lack of psychological testing. Sometimes one disorder doesn’t come to the surface right away, as was my situation, unless it’s triggered by an episode or a medication mishap.
There is something called Radical Acceptance that we learn in our Dialectical Behavioral Training (DBT) therapy, which teaches us to radically accept our current situation or condition. During those past two weeks, I utilized every trick in my arsenal of DBT skills. There is nothing I can think of that I did not try to stabilize myself . To say that this is a frustrating thing to live through is putting it very mildly.
My psychiatrist immediately switched me to a new medication that handles and addresses Bipolar 2. As the new medication started slowly taking over in my brain, I felt the Rapid Cycling start to diminish. I began to stabilize after about 4 or 5 days on the new medication.
The thing with mental illness is there are always new and exciting territories to explore in your brain. I meant that to be sarcastic. Just when you think you have your symptoms and disorder somewhat under control, something like this will come from left field and completely blind side you. During the time when I was Rapid Cycling, I remember some but not all of it. I was very suicidal during this episode needing supervision around the clock. Although my psychiatrist wanted to put me in the hospital, we opted not to because I do have a very strong support system in my family and they were there for me thank God. If you do not have a strong support system, you would require hospitalization for this.
Unfortunately, during my rage attacks, I displayed very bad behavior and although I do not remember most of it, it was horrific. I know I screamed and yelled a lot, threw things, punched things, and I also sent awful text messages and emails to people cursing them out and expressing vial obnoxious words and emotions. I was pretty much up around the clock during those two weeks, with intermittent sleep. My brother, who works night shift at the hospital, was able to stay on the phone with me when I was screaming, crying, sometimes sitting in complete catatonic silence just to be there with me on the phone while my husband was able to catch some sleep.
The one thing I want you to take away from this please is that when a disorder takes over the brain of a loved one or friend, as it did me for those two weeks of hell... We are not ourselves. It is like an alcoholic or drug addict. You must separate the person from the symptoms they display. I know that may sound like it is giving a pass to behavior that is very unacceptable in the norm. I wouldn't wish this on my worst enemy and although my brain, not drugs or alcohol brought it on per se, when we come out of it we remain with what I call a psychiatric hangover.
To look back at our behavior during the time of such an episode is very traumatic, heartbreaking, shameful, and humbling. I was not Alice those two weeks. I am not trying to dismiss my behavior, but at the same time, you must understand that I no more wanted to go through that then eat broken glass. I don't know how my family got through that with me. My mother told me yesterday that she didn't think I was going to make it out the other side. There were times when I didn't think I would either.
I am writing this to educate about mental illness, however I also want to add the empathy and advocation in here as well. There were times when my husband could have empathy for me and then other times when he just couldn't stand it and had to close the door and walk away. I just kept praying for it to end, not knowing how to manage this turmoil on an hour-by-hour basis.
My body is still recovering from the physical trauma of the panic and stress attacks, rage attacks and constant hysteria. I am exhausted and in constant fear of it happening again out of nowhere. I realize that the medication has been resolved and that I have stabilized now... Yet I will never forget this incident in my life.
During those two weeks, being incapacitated I was unable to accomplish any work, attend functions, go to the gym; I couldn't leave the house for fear of what would transpire in the outside world. I was isolated in my own living hell, with my husband.
I want to talk to clinicians for a second. My therapist and my psychiatrist were very on top of things and we were all in constant contact, mostly with my husband as my advocate, speaking on my behalf, during this episode. They chose not to just admit me to the hospital and throw up their hands and dismiss me. They treated me like a person going through a temporary episode. We all understood that if the lines crossed in the suicide ideation realm, that hospitalization would be necessary. I knew that, we all knew that. Because of the compassion shown by my therapist and psychiatrist during this time, I believe I recovered quicker and lived to tell about it. I realize that every patient is different. If I did not have the concrete support system I do, then I would have had to go to the hospital. Please take the time to listen and get to know your patient and their family and or support system. Don't just jump to conclusions, throw us in the hospital, sedate us and strap us to a bed. We are human beings with rights. My husband, daughter, and therapist acted as my advocates during this time. I thank God for them. I also know that it could have concluded in a different way without such a happy conclusion.
I bought new marshmallow peppermint body wash that I will use in the shower today for soothing. I am hoping and praying that it makes me feel better. After all, who would not feel better after dousing themselves with marshmallow and peppermint?
With you in the journey, Alice