Dx. came back more or less how I suspected it would: Bipolar I. I think it’s mostly fugue; the rest of the time I think I’m cyclothymic rather than fully BP. Rapid cycling too, just to make it a little more fun.
Cyclothymia is still one of those things that’s being studied and understood further; the translation, practically, is, we don’t know what else to call it just yet, but we’ve got a new edition of DSM to take to press, so, well…
When I went in to talk to the psychiatrist last Wednesday, I was in the middle of a full-on bipolar fugue. I was bouncing between the oh what the hell who cares depths, and the I can do it all king-of-the-world on the bow of the Titanic upswings, and even as the doctor was asking me if I had suicidal or homicidal ideation and I was saying no, no way, well, yes, I was.
In fairness, not actually planning anything. To me there is a significant difference between thinking I’d like to just die versus actually planning ways to make it happen. To my mind the latter is suicidal ideation. But, for the sake of perspective, I’ve been prone to such thoughts since I was fifteen. So I guess a better question would have been if I was relatively more prone to suicidal ideation of late. And still the answer would have been, well, sort of, maybe, I don’t know.
Rapid cycling means you don’t shift moods over months; it happens over weeks instead. Mm-hmm. There’s even ultra-rapid cycling, which is minutes or even seconds in duration. Mm–hmm.
Anyway, the good doctor suggested I try lamotrigine, which was originally designed to handle epileptics, but in 2008 was approved as a treatment for BP I. I had enough presence of mind to ask if he had any samples. He did — actually a starter pack. A month’s supply.
Don’t expect much, he warned me, not at first. It’s only a 25 mg dose, once a day. It might not take effect right away with such low levels. Well, all right.
So much for that.
It kicked in fast enough — 30 minutes after the first dose — that I actually doubted it. I figured it had to be a placebo effect. Had to be. But by 8 PM that same night, I knew there was something different. Somatically, I felt circulation return to my hands and feet. (Cold digits seem to be a physical symptom of my particular presentation.) I also felt a clench of anxiety in my gut release. Finally, I realized that my mind, which had been in overdrive earlier that day, had relaxed, and that the thrusting urge to think and produce and be and express was in idle, or at least disengaged.
That night I had the first decent night’s sleep I’d enjoyed in at least three months.
It’s not perfect. It’s not even totally regulating. I can still feel the mania pushing a little, trying to get back into full power, but it doesn’t seem to have any traction. It’s not like the lamotrigine flipped a switch; it’s more like turning a valve. It’s the difference between a flood and a trickle. A trickle I can handle. And I still haven’t worked up to the full therapeutic dose (by most guidelines).
Other behaviors seem to have fallen off as well; more on those when it’s germane. But for now, this is really quite amazing to me. I don’t feel compromised in terms of creativity — something that I was worried about — nor do I feel doped, sedated or otherwise numbed. When the energy rides high, I’m actually able to channel it into something useful. I know for a certain fact that my productivity has about doubled in the last week. I don’t expect that to last (for a number of reasons), but at least I’m not stuck holding on for dear life while the goddamned windhorse mind just gallops away beneath me.
Lamotrigine is dangerous, by the way. The worst side-effects from taking too much too soon involve a syndrome that kills off your skin’s connective tissue, leaving your epidermis to slough away in great, bloody swaths. (This is why you start with a very low dose to judge reaction and allow the body to acclimate.) The worst side-effect from dropping it at therapeutic levels (from, say, 100 mg to 0) is seizures, even in non-epileptics. So, you know, ahem.
But the odds of adverse reaction, for me, are far less significant than what I know would happen if I kept on untreated. Not suicide, but certainly not the kind of life I would prefer to live. I’ve been riding this damn cycle for at least 20 years, probably more, and I am tired, tired to fucking hell of it. This is the first time I’ve ever felt decently stable for more than a couple of days — and it happened right in the middle of a major manic episode. At this point I’d say I’m about four-fifths believing that things may actually — finally — find an equilibrium.*
I’ll follow up later, with more details as warranted. For now, for those of you who might have been concerned about me … well, things are far better than they have been in a very long time.
* How’s that for guarded optimism?
EDIT: Based solely on my own experiences, I think some people who suicide when in BP I do it as a spur of the moment thing. They don’t plan it. They just have motive, means, and opportunity (as the formula holds for crime and Murder One), and in that moment, they do it. Hey, I’ll order a pizza. Hey, I’ll shoot myself. As simple, and as immediate, and as sad as that.
It’s just that quick. Bryce, I guess I can understand your concern for me. Thank you for caring. It means a lot to me that you kept up your replies. You saw it more clearly than I did.
EDIT 2: 25 mg is not enough. Up too late. Cycles I know. Not quite enough.
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