Hypomania?

I hate having to wonder that, to analyze myself.

I typically get a little hypomanic in the spring, at least for a few days. It passes, usually without doing to much about it- maybe a couple of days of extra sleep meds or zyprexa. But the past two years, I haven't even had that hypomania.

Sometimes hypomania is pleasant, and sometimes it turns very unpleasant- irritable, etc. So it is hard to say if I miss it. I miss the nice hypomania I guess.

Tonight I slept for 3 hours, and then I woke up. And now I am awake, and I don't even want to get back to sleep. I actually washed a few dishes, went through some papers, but mostly watched the TV news coverage of the primaries. I have to stop doing that.

I ate lunch in my car today, sitting in the sun. Is that enough to set me off? Or maybe it is just one sleepless night. I don't feel too racy. I just don't want to sleep. But I feel like I "should" be sleeping, like if I don't I will pay for it tomorrow. So I will give it another try for a couple of hours. I have to get up soon anyway.

I think I'm quitting therapy

I found myself dreading my therapy session tomorrow. Because I didn't want to admit that I haven't done much studying. Because I didn't want to admit that I went back up to 5mg of Zyprexa, at least for the moment. I just don't want to have to explain myself to anyone, if I don't want to.

And I know what I am doing with meds for the next month or so- nothing! No changes. I have come down some already, I will just try to maintain that. At my next vacation, I will reduce something a little bit more. But this is going to be a very, very long process. And I suspect I won't be able to get off of everything.

And I think I also did in therapy what I have to periodically do- which is to tell my story of my crazy past. OK, so now what? She's not the person to discuss my concerns about meds with. I don't want to do DBT. Now that I have found a support group, even if I do not get myself there every week, just knowing it is there- I feel like I am less in need of just a supportive relationship.

I don't believe in therapy forever, at least not for me. And I have certainly had a lot of therapy. It is time to stop. I know what I need to do to make my life better. Whether I do it or not- it is up to me.

Plus, I won't have to be taking money from my parents for therapy.

Am I wrong about this? It is not often that I find a therapist who I like, and who has been useful. Most of them are really bad. Do I want to give this up before I am sure it isn't going to help anymore, especially when I am getting help paying for it? And maybe this forced weekly social interaction is a good thing?

I don't know.

I feel a ton better- and I almost wish I didn't

Feeling so much better on my 5mg of Zyprexa. If I didn't, the choice would be obvious, get off of the stuff. Now I don't know what I am going to do. Perhaps put my "quitting" efforts on hold until after November, when I take my exam. Which is really what makes the most sense.

Is it possible to get off of Zyprexa after 12 years? Or does it change your brain so much during that time that you need it to function normally? Or, am I one of those few people for whom maintenance use of Zyprexa might actually be a good thing? For whom the benefits might outweigh the harm?

I don't see my psychiatrist until May. And I won't even have the time to discuss these matters with him, as I have something else I need to discuss, and a form I need to get filled out. The idea that we can see a psychiatrist for 15-30 minutes every couple of months- where did that come from? Medication is much too complicated for that. These types of visits encourage the use of maintenance medication- just keep taking what you are taking for the next 3 months until your next appointment, and then, there really isn't time to make major changes. If you stop taking a medication before your next appointment, many doctors will consider you non-compliant. But maybe you didn't have to take it that long.

My psychiatrist would see me as often as I want. But I pay privately out of pocket, and for what I pay him, I'm not going to see him too often. He is a very good psychiatrist- plus, very respectful of patient autonomy. But, he is very much a psychopharmacologist, very pro-drug. He doesn't like using Zyprexa because of the weight gain, but otherwise he is pretty quick to prescribe the antipsychotics.

I guess I wanted this to be easier

I have wanted to be off of Zyprexa since about almost as long as I have been on it- after about 3 or 4 weeks I got tired of being so numbed out and tried to go off of it, with a resulting hospitalization as I got agitated during withdrawal. Subsequent attempts haven't been any more successful.

This time I got impatient, I went too fast. I have to go up a little, be slower to go down. I have too much at stake. I have to function. I have a life. Zyprexa has made me obese. It is doing bad things to my brain, as does any antipsychotic. But it is damn hard to stop. Much harder than klonopin or adderall.

If I can't concentrate enough to do my notes at work- this is not sustainable. Forget how I feel... as if I could. But I can't get myself fired. I have to take my Zyprexa, for now. At 5mg, I was concentrating pretty well on Zyrexa. Any higher and it was definitely bad news, but at 5mg I seemed to do okay. I can only hope that at 5mg it is not doing too much damage.

I want to stop thinking about meds. I want to just live. All this thinking about meds makes me feel more like a mental patient, not less. Normally, I really don't think about it all that much anymore. I am just different- I do feel that. How can I not when I live in this family-centered town and I am about the only person my age with no husband, no children? Of course I feel different. Even without my past. But different is just different.

What I was hoping that my "mood disorder" would become like my hypertension. I take meds for it, it is controlled. I don't go around thinking of myself as someone with hypertension, although I know that I am. Twice a year I see my doctor, she adjusts my meds if necessary- tells me to exercise more, lose weight, and I am on my way.

I know that at times meds made me worse- but I blamed that on bad doctors. I was thinking that, perhaps, I am "doing well" now because of my meds, just like my blood pressure. But now the evidence seems to be that, for most people, the meds worsen long-term outcomes. And I don't know what to do about that. It seems like I need to do something.

There has always been a part of me that wondered, to what extent am I doing well in spite of my meds, not because of them.

And who really knows.

Struggling Today

I have been depressed and out of the the past two days, and very tired. Last night I actually got out of work early, but was too tired to go to my support group, and I needed to go. If my fellow "crazy people" won't understand what I am going through with medication, who will? And I need to talk about it, but there really isn't anyone to talk to who understands.

I think I need to take a break from going down any further. My irritable bowel syndrome is really bad again. My concentration is shot, I hardly wrote any notes at work in 2 days. My sleep is broken. My mood is going south. I have constant headaches.

But I'm not going back up. I am not giving in. If I go back up on the Effexor, I'll need another blood pressure medicine- I'm already maxed out on my ACE inhibitor. And there is no way I am going back up on the Zyprexa. If I have to hang out on 2.5mg for a while before I can get off of it, so be it, but I'm not going through this again.

I want to get away. I want to go backpacking. I don't know when that will happen, I don't have any time off until May. Maybe Sunday I will go hiking. But that means not doing a bunch of other things that need doing, and not studying. Still, I think I have to go.

How long to taper?

So far so good on the Zyprexa decrease. I have had some problems sleeping, but not as bad as in the past. I have had some mood swings, but not too bad either. I had about two days of depression, and now I am just moody. No irritability, no signs of hypomania.

Two nights ago I gave in the insomnia and took a full 10mg of Ambien- I normally only take 5mg- but, as usual, the cognitive side effects were too severe and I really couldn't do any paperwork before lunchtime. So no more, it is better to be sleep deprived.

I do feel more alive. Like parts of my mind are starting to wake up. It is subtle, but it is there.

But it is also scary- the thought of going completely off of Zyprexa. Of all the meds I currently take, that is the one I have been taking for the longest, my guess is about 12 years. And in those 12 years I managed get myself off of disability, get a Master's degree in OT, and work for 8 years as an occupational therapist. But it is easy to confuse correlation with causation. And I really think that in those 12 years, I just wasn't so miss-medicated so as to make me manic and rapid cycle. Really, the depressions have continued to a large extent. But positive experience has built upon positive experience, and work has really been what has made me better. And, I feel like I should be further in my life than I am. Things are still very hard.

As predicted, my therapist is not too happy with me reducing my meds again so soon. But she says that she will support me.

She asked me what I am going to do about my other meds. And I told her that I don't know- at least for now. Ultimately, I want to get off of whatever I can get off of, but my priority has always been the Zyprexa. I'm not sure if I am doing this in the right order- maybe I should get off of the antidepressant first- but I do take another mood stabilizer.

Work is going well. But I am not studying like I need to be. I am too consumed with this, with meds. I hate this. I don't want to be thinking about meds all of the time- and yet, how can I not be, when I am learning how much of what I assumed to be true about them is actually false?

Interestingly, I may find a reason to stay on my antidepressant that has nothing to do with depression! Since I lowered my Effexor, my irritable bowel syndrome has been acting up. It really wasn't too bad though, until today, when I had to keep running to the bathroom at work. But then I started wondering, are antidepressants any better for IBS than depression in the long run- maybe they don't work for that either? And I am just having withdrawal effects.

If I had any doubts...

If I had any doubts about wanting to get off of the last bit of my Zyprexa, they are gone. There is a new study out in Psychological Medicene (an online journal) showing that schizophrenics, as well as people with psychosis due to mood disorders, do much better if they go off of their anti-psychotics. It is there at 2 years, but over time, the effect is much, much bigger. If this effect were a drug, everyone would want it.

The authors say, the people who go off of their meds had a higher premorbid status, and a more internal locus of control. Basically, what this means to me, is that they identify less as psych patients. But still, medication is considered so fundamental to the treatment of psychotic disorders- you would not expect to see this. Not fewer relapses, more periods of remission with no meds.

There was a time I thought I had made my peace with my 5mg of Zyprexa that I was down to. OK, it will take years off of my life. But it is about quality of life, not quantity of life, I told myself. But if it is not even making me better!

I have tried to go off of it before, of course. First because it made me numb. Then because it made me fat. And then when I read about antipsychotics shrinking brain volume- I decided I really had to get off of it. Which, I guess tells you my priorities. You can make me fat, but don't make me dumb!

But in the past, I never properly understood that what I was experiencing when I tried to go off of it was a withdrawal effect. I thought that the insomnia, the mood instability, and often the irritability that followed just proved that I really was bipolar, and really needed the drug. Afterall, my experience with mania had been so severe- although I think that it was all medication induced.

But I am far away from the mania now- years away- that I don't fear it anymore. And I know how to control it, anyway. Going back on tegretol will do it, if I have to. And in the short term, I can knock it out with Zyprexa if I have to. Things won't get out of hand. The short hypomania's that I get, even though sometimes they are mixed and unpleasant, I can handle. Worst case senario- I go shopping. But I don't spend enough even when I do that it is worth medicating myself over. And sometimes I have fun!

I am getting off of Zyprexa. I just don't know how fast. I have been at 2.5mg for a few days, less that a week. I should probably give it a little more. And I should probably call my psychiatrist for some 2.5mg pills so I can cut them in half.

One thing that scares me about going off too fast- besides my normal withdrawal effects. There is this one blogger who says that to withdraw from Zyprexa can itself cause more damage to the brain and body than staying on it, because of all of the things that Zyprexa affects via some of its non-D2 receptor binding. And I don't know what to make of this. So I am taking lots of anti-oxidants, and hoping for the best. But I think slow is better, when it comes to getting off of this- even if I'd like to do it faster.