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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