I’ve been in the depths of a bipolar depressive state for some time now — months of being curled up in the figurative fetal position at the bottom of the abyss, so to speak, the surface smooth as glass and curved at a precipitous angle, with no footholds with which to claw one’s way out, fingertips raw and bloody with the trying, regardless.
I’d been trying, futilely, to get an appointment with a psychiatrist for months — nearly a year. This is the state of things since the world has gone wonky with Covid, and psychiatric care in the US has been put on the back burner. Years ago, say about a dozen, if I wanted to get in to see a shrink, I could do so easily. These days, not so much. And if you don’t know how to advocate for yourself, and are depressed and unmotivated as a result (not your fault by the way, the lack of motivation from a deep depression is real), it’s easy to be discouraged, after making a dozen calls to try and find a doctor who will take your insurance, has an appointment open in the next six months, and is the correct gender, if that matters to you — and if you are a woman, that can be very important if you, like one out of three women, have been sexually assaulted and don’t want a man digging around in your head, discussing these traumas.
I finally found a doctor, after calling a crisis line — the final step before I was ready to throw in the towel and just throw myself on the mercies of the best ER in the area, one that I know would be kind and decent to someone in a psychiatric emergency; which would very likely entail going inpatient. This is always a last resort, and was something I really wanted to avoid, because it would mean leaving the Paterfamilias and my cats for potentially two weeks, if not more, depending on how sick they deemed I really was. And so, I called the crisis line of the place I took my son and myself to, when he was still alive, and we were both in need of help, about 13 years previous.
They sent a team of two crisis workers to me the very next day — this was two weeks ago — and since then, my life has slowly begun to transform. I don’t think I need to say, for the better. They have done for me what I have been doing, in my job as caregiver for the past 9 years working with the mentally ill, and it has been incredibly strange being on the opposite side of things. Just being able to put myself in someone else’s hands, and let them take care of all the myriad things that I need to happen to get my life back in order, since things fell apart after losing my job due to my health, and my resulting depression. There was also an abusive relationship that I haven’t entirely recuperated from, financially, mentally, and emotionally — or physically. There are many things that need to happen in order to get things back on track, but first and foremost, I need to get my head right — and I have been under-medicated for over a year, now.
Even more important than my physical health, my mental health is paramount — because I can’t properly manage my illness if I’m too depressed to get out of bed. It also exacerbates my pain, and casts a pall over everything that is like thick molasses, or quicksand.
And so, my new social worker helped me find a psychiatrist. The downside is, the appointment isn’t until JULY. I knew I wasn’t going to be able to hold on until then, with the spiraling depression, and the mixed states of hypomania making it impossible to sleep. I already know which medications I am optimally functioning on, so it’s just a matter of talking to a doctor. My primary care doc refuses to prescribe my meds to me, even though he knows which ones I was on previously. I’m sure it’s a matter of protocol or whatever, but it’s extremely frustrating. So, I knew I was back where I started — I was going to have to find someone to see me NOW, or go to the ER. So, I gathered my mental resources and did another web search — this time for online psychiatrists, who would do virtual visits. What did I have to lose, after all? The challenge being finding one who would take Medicaid.
Turns out, in this age of COVID, it wasn’t nearly as hard as I expected it to be. There was a new service available, Mindful Care (no, I’m not shilling for them, but I did have a really good experience with them, so I’m going to talk about it) that I hadn’t run into even a year ago during my initial search for psychiatric care (back then, none of the online services took Medicaid — things change quickly in the age of COVID). I punched in my insurance, and Lo and Behold, they accepted mine! I did the five minute intake questionnaire, and within the hour, a real live human being got back to me via text, and the next thing I knew, I had a Zoom appointment for the next day.
I spoke with a prescribing psych nurse, and the appointment took about an hour — she was very thorough, and actually listened to me, and because I am good at advocating for myself after all these years, and know what works for me, she gave me the meds I requested, at the low starting doses, of course, and will call me in two weeks for a follow-up to see how I’m doing, and to titrate the lamotrigine up another 25mg. And so, now I wait. This is the part that’s a bit hard, because it requires patience — you know that you’re on the road to feeling better, but it’s going to take at least two weeks before you feel anything at all, mood-wise, while your body might start to feel weird symptoms right away, like gastrointestinal distress, nausea, etc.
Because I have an eating disorder, my doctors and I are always careful about what meds I am on — I take ones that won’t cause weight gain, because that would spiral me into bad behaviors and non-compliance with the meds. I’m confident about the combination of meds I’m on now, because I know I’ll be safe in that regard, and I just need to get through the couple weeks of weird stomach discomfort and nausea, brain-fog, and spaciness — all of which is normal, and all of which will go away within a month or so.
This is the stuff that trips a lot of people up — firstly, they expect the meds to work right away, and they get upset when they don’t. Realistically, I won’t feel any improvements for at least a month or so — and the real difference will start to occur at about the two month mark. Secondly, people get discouraged by the side effects, which almost always resolve themselves right about the time the meds start to really start working properly. Granted, they can be annoying, but they’re almost never permanent. The one thing that can be bad is the weight gain from some of the meds, but there are ways around that. There are medications that can counteract the weight gain, and there are meds that actually DON’T cause weight gain to begin with. Both solutions are things that should be worked out with your psychiatrist, and if they aren’t willing to work with you if the weight gain is a real concern, like you gained significant weight due to the meds, then you should switch doctors.
That in fact goes for any issue you might have with your doctor — if they don’t listen to you, don’t respect you as a patient, then it is absolutely within your rights to fire them and move on. I’ve done it twice in my life, and never regretted the choice — although I’ve never had to do it with psychiatrists, only medical doctors. I’ve had great experiences with psychiatrists, fortunately — possibly because I speak the language, as I wanted to be one myself, had my health not gotten in the way. But I’m well-educated in the medications, the terminology, and the illnesses, and I’ve worked with the mentally ill in a caregiving capacity for many years — all of which pays off when talking to my own psychiatrists.
And so, I’ve decided to document my progress here on the blog, with the meds, now that I’m back on all of them again, after many months of only having one mood stabilizer, and Hydroxyzine for anxiety holding me together. I now have Wellbutrin XR, Lamictal, Topomax, Hydroxyzine, and Seroquel, which I take as needed for insomnia, and psychosis (the latter being a rare occurrence with me). These are the meds which have worked best for me, over the years — however, brain chemistry is a funny thing, and what worked a couple years ago could possibly not work as well, now. So, we shall see — but I expect the only thing that may need to be changed would be the SSRI, because they can cause manic states in Bipolar people. In which case I would either up the dose of mood stabilizer, or switch from Wellbutrin to something like Zoloft. However, I am on the lowest possible dose of Wellbutrin, and intend to stay on it, because I’ve only experienced mania and intense anxiety when on higher doses.
Today will be a full 24 hours of being on my new meds, and of course, the only thing I feel is a bit of nausea, and I was able to get to sleep easily after taking the Seroquel — which is a fast-acting drug when taken for insomnia. I’ll be taking it nightly until the insomnia passes, because I haven’t been able to sleep at night for weeks, now — and it’s definitely taking a toll on me. I feel better in that respect, already — I was able to wake at 8:30, and shower for the first time in a week (I know, gross, but I’ve gone longer in a depressive state). I can’t describe how much better a shower can make you feel; the negative feedback loop of not taking care of yourself in that simple way is insidious, and I hate it so much. But since I’ve gone so far as to shower, I am going to try and make myself take a walk, today, too — I took one yesterday, when I picked up the meds, and today it’s going to be 70 degrees out. I think I’ll try to make it to the lake, which is close by. I even swept my floor, earlier.
That’s the other thing — there is a definite placebo effect of starting meds, that can’t be discounted. It’s a real thing. You know you’ll be feeling better soon — that you took a positive step, and that alone gives you a serotonin boost. Also, Wellbutrin is the sole anti-depressant that is very fast-acting — it can start having an effect within a few days, and I am hyper-sensitive to these medications, so it’s very possible that I’ll start feeling real effects within a week. That in itself is very encouraging, because I have a lot of appointments coming up with the counselors, and I want to apply for school soon, as well. And for that, I can’t be stuck in a depressive hole. I need to do the absolute best I can to get a handle on my mental health — and although I have fairly difficult to treat Bipolar depression when it hits this hard, I know that it’s not impossible to at least improve it, to make myself more functional that I have been in recent months.
I’ve been fighting this shit my entire life — for as far back as I can remember. My health doesn’t make this any easier. But one thing I do know for certain is that being unmedicated is the worst possible thing when you are mentally ill. Bipolar disease is exactly that — a disease of the mind. And how do we treat disease? With medication. And do we stigmatize people with any other disease they are born with? We do not. I am frustrated that it took so long to get the help I needed, but I’m not going to dwell too much on it — because I’m finally on my meds again, and soon I’ll start feeling like a human being again, able to function, able to socialize and enjoy my life again. It’s been a very, very long time since I’ve been able to do so.
I am grateful that I live in a time that I can enjoy better living through chemistry. So, stay tuned, I’ll be back…
Bare Bones Blonde 
Leave a comment