Category Archives: Medication

Bipolar – Hypomania – What Can I Do?

A response to a question from a reader on my Facebook page: Bipolar 2.0.

­­I was recently asked a question over on my Facebook page (Bipolar 2.0) and thought I would share the answer here for anyone else who wonders the same thing. (This blog automatically posts on that page as well.)

Q: How do you cope with hypomania? I usually work out hard, take a nap, or watch TV. Usually I take a Klonopin any other medicine you have used to cope. Thanks

A: I can’t say anything as to medications, but I use Klonopin (also known as Clonazepam) as my “rescue” (chill pill) pill when I can’t cope anymore. This is in addition to my prescribed daily mood stabilizers. I would suggest that if you’re really struggling to maintain control that you visit your doctor again and make sure they really listen to your concerns. It’s important that things not get out of control, right?

I do think that your coping techniques are really good. You seem to know yourself well and have figured out what can help mitigate some of your symptoms. Do those activities work for you?

Right now, Klonopin is the only thing that makes me STOP. No amount of exercise, sleeping, writing, TV, gardening, walking the dog, playing with the dog, blah, blah…. Sometimes nothing works. My meds have been tweaked and tweaked for so many years… it’s painful just to think about it.

So, I’m suggesting you talk to your doctor and see what she thinks. Then, you dig in and dive down the rabbit hole and find more fantastically creative ways you can find to help yourself… in case they don’t have any answers you like, find alternatives that you can try that aren’t medications, but that might have good outcomes for you.

One day I started on YouTube looking for something on mediation and I found a whole world of different meditation, sounds, music, voices, stories, mindfulness, relaxation, and much more. I made an obsessive number of playlists. Ok, I lost my mind and made way too many, but I have narrowed it down to some playlists that I play every night on my iPad (I pay for YouTube Premium so there aren’t any ads).

And yes, I am manic. And, yes, I also have ADHD. So, I’ll stop… in a second.  

If you can keep yourself busy, not just busy, but productive. If you can set some goals and meet them. If you can use that energy to propel yourself to someplace you want to be or become someone you want to become, then use that energy to do that. Don’t let it burn you out or rob you of your life. Take hold of it. It’s hard and complicated and ridiculous that I’d say it can become a good thing I suppose, but it can be. I think it must be. At least… for me it does. My search goes on…

Therapy choice #1.

Opioid Dependence and Mental Illness

Pile of pills

I’m not an addict. I’m not! I’m mentally ill. I have Bipolar Disorder. I also suffer from chronic pain in my lower back.

My primary care doctor (PC… PCD? Uhh… let’s go with MD) had been prescribing me oxycodone for the server and persistent (chronic) pain that I’ve had for years. After being active and doing something super strenuous like gardening for 15 minutes I think I’m dying. I’m exaggerating of course, but when I work as hard as Atlas does while holding up the world my eyes leak, I whimper and sit down. Sometimes I end up laying on the floor. The floor is such a very bad idea. If I straighten my legs my whimpering becomes desperate and I realize I’m crying. If I forget myself and straighten my legs I’m done. I can’t move. The pain paralyzes me.

I’m NOT an addict.

When I can think again, I try to find my phone. If I can’t find it right away I feel the panic rising and it triggers thoughts and emotions I thought I’d had under control.

This last time I thought I was managing my mania and depression (mixed state, rapid cycling) pretty well. I haven’t bought piles and piles of books on ducks or Oprah or how to be an astronaut. Honestly, I really haven’t. But please, don’t ask me what I’m thinking about. Also, I’ve been able to get out of bed AND wake-up in the morning and even go for walks. My depression skips through the dandelions with the mania comingling into a mixed state, which is always confusing.

I’m not an addict.

After many months of giving me a legal way to get my the Oxycodone I take for pain legally, and for free. The label on the bottle says I’m to take the little unassuming pills three times a day. They are 20 mg. Currently, I’ve convinced the assistant fellow at the pain clinic to reduce my Oxycodone to 20 mg twice a day.

I’m not an addict.

I’m mentally ill. I have Bipolar Disorder, ADHD, chronic pain, and other stuff.

I was referred to a pain chronic clinic… ah… chronic pain clinic, where my Oxycodone prescription was reissued. A five-minute verbal probe, that’s what it took for the doctor to determine whether or not I needed the narcotic. We didn’t talk about Bipolar Disorder or any potential interactions the Oxycodone might have with drugs that are meant to manage my wild emotions or tame my fantastic panic attacks. I’m not certain she has any record of my current medications. She asked questions, and I quickly tailored my answers to fit what I thought she was waiting to hear. She made a few notes on a paper as small as her palm. I wondered if she was actually making notes that she could refer to later. She thought for a few seconds and then wrote the prescription. I sighed in relief.

I’m not an addict.

A while later, like over a year or maybe two, I’m still taking the narcotic. The clinic has new owners and staff. They no longer asked me questions. Sometimes they required a urine test. Then, they stopped asking me anything at all. We spent my appointment chatting. I started asking if we could please try to figure out what was causing the pain and try to deal with it by correcting the problem. I wanted the pain to stop.

They didn’t listen. They wrote the prescription without hesitation.

I’m telling you, I’m not an addict.

My mental health drug dispenser began paying attention after I updated her about my drugs and included Oxycodone in the list. She stopped talking about whether or not my meds were working to stabilize my moods and started talking about “Black box” warnings.

She had my attention. I started to panic.

At the time I had over five medical people prescribing medications. They didn’t know what the other office prescribed me. They relied on me to tell them the truth. I didn’t have to tell anyone I was taking Oxycodone. That got me thinking.

I’m not an addict.

Later…

I’m still asking the medical folks to figure out the cause of my chronic lower back pain. I’m still not getting results. I’m getting way too much Oxycodone every bloody month.

Because I can, I’ve been researching my of collages of illnesses, disorders, and psychological malfunctions.

Ah ha! Black box warning. Do NOT take anti-anxiety medication (benzine’s) – death may result.

Oxycodone 20 mg

I recently saw Dr. T, my very superior knee surgeon. He saw the condition of my spine when he was looking at the x-rays of my hips. He was making certain that my persistent knee pain, post second replacement, wasn’t being caused by anything running amock in my hips. He was eliminating any possible cause of my knee pain before he even considering using surgery to further correct the inept effort Dr. B made the initial knee replacement. Dr. B successfully replaced my knee, but that’s where the project ended.

It sucked. My leg from the knee down, well, it kind of turned the wrong way.

Dr. T corrected the first replacement. He tried to minimize the damage his surgery could do while trying not to blow up my entire joint… okay, the joint that was already gone.

Dr. T showed me the x-rays he’d just had taken and explained where and why he left Dr. B’s “efforts,” while replacing the replacement. A month ago we tried a shot to relieve the pain and keep from having to have surgery again.

Nope. I’ve had no relief from the pain. In fact, my brain was overjoyed and thought that my knee was doing awesome. Holy cow! I should NOT have knelt down like that! Looks like surgery is probably what our next conversation will be about. I’ll need to be on pain medication again…. I intend to be off Oxycodine ASAP. I would really like to have some kind of painkiller to take after surgery – assuming I have it. Always be prepared! Sigh…

I’m not an addict.

After my constant complaining about my back pain that happens every time, I do regular human type activities involving the lower back. I’ve finally had x-rays of my back taken. Holy heck. Next stop is at a spine doctor.

The online personal information provided by my medical organization includes this: Opioid Dependence.

My chronic pain clinic instructs me to continue taking the Oxycodone. I haven’t been able to identify any specific relief from the pain in a long time. I have never felt any “fun” results from taking it. It has never made me feel sleepy.

I have found that taking Oxycodone at bedtime with the medication I take for Restless Legs Syndrome (RLS) helps me to get to sleep and not wake up in agony caused by the RLS.

Am I an addict?

“Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety). Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.”*

I’m mentally ill. In my opinion taking any medication, especially one that alters my brain chemistry (opioids do this), should be thought about and discussed with other medical personnel who are also responsible for my continued living – and to live my best life.

Am I an addict?

No.

I have Opioid Dependence.

Dependence. I can live with that, but look, let’s get rid of that too. Okay?

{I have Bipolar Disorder. I’m a little manic now. I’m using it to write and post while I can. So, for now, I will post often because tomorrow, I may be depressed and unable to say what’s on my mind. I may not have anything on my mind.}

* https://ghr.nlm.nih.gov/condition/opioid-addiction

What My Med Provider Means to Me

burning-ice-cubes-640x402
I’ve complained about my med providers and their apparent inability to comprehend the word ANXIETY for over a year now. You could assume that I don’t like med providers… that I don’t trust them, that I think they’re stupid. Well, umm, yes, that’s basically how I’ve been feeling. I’ve been living a nightmare that has been driving me downward toward my old companions: anger and rage. It makes me feel like they’re getting out of prison and are moving into the house next to mine. I’ve been really scared that I was about to lose control of my emotions again, and eventually, my mind. It has happened before.

I last week I spoke with my counselor (Lee) before my visit with my med provider (Susan) this week. He thought the Ritalin obviously wasn’t working and that my ADHD was out of control. I allowed myself to interact with him the way I do at home with Jessica. My inability to control things like how fast, how much, and how many topics I covered while speaking certainly indicated that this was true.

<OMG! Alexa is playing music from the 1950’s for me. I LOVE THIS MUSIC!>

I was stunned. ADHD? If he was right, this could change everything about the way I approached my brain. I was told I had ADHD just a few years ago and had never taken the time to learn anything about it. Wow, that wasn’t like me at all. I love research! Following rabbit holes is my favorite pastime!

Anyway, I assumed Susan would look at my chart to see what notes Lee would have put in it before she saw me. Doing that would give her knowledge she should have used to help her understand where I was at and she would have seen what Lee was concerned about. It was an assumption I shouldn’t have made. Apparently, things don’t actually work that way.

Every time I see Susan 12 times a year. Yikes! So many times. One of the first things she asks me is if I feel like… if I FEEL like the Ritalin {1} is helping me focus? Focus? What does that mean? How can I tell it’s working? I can pay attention in class. Is that what she means? My attention is crap at home. I can’t ever do just one thing at a time. I have to leave the commercials in when I watch from the DVR (DISH) so that I can read or research stuff online that they just talked about. Is it working? I suppose so? I always replied that I guessed it did. I guess that was silly of me. I would say that because I had no idea what else to say. If I was a little boy, I could probably mean that I’d slow down and stop bouncing off the walls and maybe stay in my seat. But as an adult… I had no idea what that looked like. If I said the wrong thing, she might mess with my meds and right then, they were treating me okay. I wasn’t raging at anyone that day and I didn’t feel depressed.

After I mentioned what Lee and I had talked about and that he was very concerned she took a minute to read his notes. Suddenly she made a whole new treatment plan. I had been on Lithium when I was first diagnosed with Bipolar Disorder (BD). The first book I read on it was: “An Unquiet Mind: A Memoir of Moods and Madness” by Kay Redfield Jamison. I was deeply touched. I felt like I understood what she was talking about, like we were kindred spirits, linked through the ether by BD. Jamison was very sick when she was diagnosed.

Let me attempt to generally get right to the point for once. Jamison was placed on Lithium to treat her BD and it worked. So, that’s what I asked to be given. My personal doctor (MD), was the one who initially treated me. He said that Lithium has been around for many years and there is a lot of evidence that it works.

The Lithium worked.

Susan felt that since the Ritalin was obviously not helping me focus. I guess that made her rethink her strategy. She finally agreed that my brain was hopping along on two of four legs. She told me that does think I have ADHD she now believes that I’m far more manic, which was making me act like that bouncy ball they teach kids to sing songs with. Do you know what I mean? It might be too old for some of you. They wanted to teach kids songs so a character on a film or on TV would get you to sing along as it had a bouncing ball hop around on the lyrics so we could see the lyrics while we sang. It was great fun! than anything else. Sure I talk incessantly to Jessica, but my brain was exploding with ideas. It was time to help me continue to be creative, but to control my mania so that I could be productive.

The plan: no more Clonazepam, no more Ritalin. Start Lithium.
*The reason I went off Lithium was that my PC (Primary Care) had been highlighting the dangers of being on Lithium more than he was the benefits of it. It was because of these side effects, that I requested I be put on something else that didn’t have the same drawbacks. Lithium toxicity can occur even at a low dose. While on Lithium, the user has to be closely monitored so that the dose can be adjusted as needed. The symptoms of Lithium toxicity are numerous and I already have several of them for other random reasons. This website lists the long lists of side effects. In addition to these potential problems the user (remember this is me) has to carefully watch their intake of salt, caffeine, and alcohol. And get this… some of the other medications that may interfere with Lithium and increase the risk of toxicity are ibuprofen (Motrin, Advil) and naproxen (Aleve). Oh, and I can’t leave out this one: acetaminophen (Tylenol). So… yeah. I had a lot of scary reasons to ask to be taken off the drug that was helping me but was also kind of terrifying too. 

Susan believes that this change in medications should make my extreme moods in control much better.

Excuse me? As long as I’ve been seeing the professionals in this clinic, I’ve never had anyone decide to try Lithium again. All this time… lost. Years of feeling my little grey cells melting, running out of my ears. But then again, Lithium toxicity…

I want to be a writer when I grow up. I once heard that writers go through life with their head cocked a bit to the side. I showed Susan a piece of paper that was covered with writing on both sides. It was filled with websites, blogs, and email addresses that I’d created. She studied it for a while. I asked her if I was stupid and delusional to think that I could do all these things and believe that they were not just good ideas, they were great ideas. They were creative ideas. Is my mind actually existing in a consistent state of delusions of grandeur?

Delusions of grandeur. I’ve always been afraid that people would remember that part of the list of symptoms for BD and dismiss me as a kook. Am I brilliant? Or am I bonkers and deluded? I’ve always believed my ideas were great. Yeah. Delusions of grandeur?

She said no. It wasn’t that. Yes, my thoughts are crazy fast, but I am very creative and smart.

Me – creative and smart. OMG!

Of course, now I respect her. She believes in me. She agrees with me that I’m smart and creative. No one has really said that to me. No one has said, “Robin, you’re not delusional. You’re smart. You’re creative. You have good ideas… cleaver… innovative. Don’t worry about being crazy. We just need to slow you down so you can get things done.

Since then, I’ve discovered additional information that indicates that one aspect of BD is the tendency to be super goal oriented. Yep, that’s me. Why haven’t I’ve seen that before?

Watch out! Corner coming!

What are the good things about having BD? I’ll have to think on that for a while.

Go ahead, get mad when the medical professionals don’t seem to be listening. Pester them until they hear you. Then, you listen to them. Work together. Hope that things will finally start to workout. Now that Susan and I are communicating, now that she hears me, we have a new plan. Maybe my mind won’t keep leaving the scene without me.

Yes, it really has done that. We’ve called professional trackers to find it a few times now. It-is-very-embarrassing when your mind is so exposed, so naked.

New plan. New hope.

Bring it! I’m ready.

I’m more than ready –

{1 – Concerta and Ritalin are stimulant medications used to treat attention deficit hyperactivity disorder (ADHD). They’re both different brand-name versions of the same drug, called methylphenidate hydrochloride.  https://www.healthline.com/health/adhd/concerta-ritalin}

Frankenstein – Bipolar & ADHD

Frankenstein-tumblr_ovgh5egVdd1wzx3t8o1_1280 I’m aware, that when given the chance, I will, without question, talk until the air has been sucked out of the general area and everyone has passed out. So normal.

Anxiety – After I graduated, and a few weeks had passed I could tell I was under stress from that. My anxiety has gone down. It did get better, for a while. I got to the point where I didn’t quite feel like my brain has been stuffed full of raging bees. Awesome!

ADHD – I was under the assumption that I was taking Ritalin to help me focus my attention so I could do well in my classes. I was always confused when my med provider asked me if I felt the Ritalin she was prescribing was helping me to focus better. I always said, and continue to say, “Um… I guess so.” I’m manic! What does she want me to say? I work very hard when I meet with her to sit, shut up, and answer her questions honestly. She terrifies me. What if I answer wrong and she changes my meds again? I’ll say something than think, “Crap! Why did I say that?” I always say that I guess it was working well. I suppose. Now I think that I was wrong.

More ADHD – I accepted the diagnosis of having ADHD because it was about not being able to focus on one thing at a time and I knew I couldn’t do that. But, being Bipolar was always the main objective of both my counseling sessions and appointment with the med woman.

Bipolar 1 – I assumed that my Bipolar was worse (or more dangerous to me) than ADHD could be. Wasn’t it?

You know how a doctor will sometimes leave a small tube that goes through an incision so that the area can drain and heal properly?

Yeah, I don’t know where I was going with that—

Switch – I have some ideas that I think are pretty good. I’ve done one or two or three big projects that have come out great. The other 45 ideas that are going around in my mind appeared to be stuck in orbit. I remember the video I watched on YouTube yesterday about ADHD and I was shocked. Frankenstein!

FRANKENSTEIN – I’ve come to think of Bipolar/ADHD as a Frankenstein type of symbiotic relationship. I can’t imagine why my diagnoses has always focused upon Bipolar Disorder. In counseling I talk faster and faster and cover an impressive variety of topics.

Pressured Speech (Bipolar) – Thought very little about ADHD or how to deal successfully with it. I’ve been taking medication for it for three years. In that time no one has talked to me taught me to handle it. Why not?

FRANKENSTEIN – Why hasn’t anyone explained how the two disorders interact, and how the medications for each may also affect each other. (“Do you think that the Ritalin is making your mania worse?”)

I have been primarily a mixed state, high functioning, Bipolar type 1 for years now. I always thought that my constant mental zooming about was just my amazingly stunning mania. (While I mostly talk about my being manic lately, let me just say that depression has played a big part in my mental health too.)

My daughter went with me to my last counseling appointment. We talked about my inability to stick with one thing and see it through to completion and how it was impacting her. Basically, I’m driving her bonkers. These are some of the things that I do: TALK CONSTANTLY NO MATTER WHAT WE ARE DOING, change topics as fast as I talk, pick up a pile of laundry in the living room to put it away, stopping to talk to our beta fish (Victor and Batman) and feed them a few dried wormy things and set down the laundry, forget that I had a mission with the laundry, see that the dog/cats water bowls are empty and fill them, read 1.75 pages in a book. What was I doing? Let the dog out to do her business. Hours later I discover the laundry next to the fish… you get the idea.

My new counselor, my daughter and I decided that I need to focus on being able to focus. Yes, my Bipolar mania hops it up like jet fuel in a race car, but with knowledge and tools to help me with my ADHD and settle on one thing, even for an hour, I might just begin to get a handle on my anxiety/stress and even mania.

Maybe. This is stressing me out. Bothering my daughter this bad is building an anxiety that is part of everyday life. Sigh…

Who knew that pressured speech and mania aren’t the same thing as ADHD? I really don’t understand what the hell is going on. I feel like my brain has been sewn together with blue and green colored twine and slip knots.

One final thing: It has taken me three days and four hours to type this. Just kidding. Two days. Honestly, I have no idea. I need a time-out.

I’m Bipolar 1-How Much Further Must I Go?

I’m dang angry. I’ve worked my agitated ass off for three years, stumbling under the nightmares of depression and raging as anxiety unleashed tries to undo all that I’ve endured. So close. One more quarter and I’ll graduate from UWT. One more quarter and I’ll have to get a job and support myself.

Listen to me dear Reader, if you have a medical professional who won’t listen to you or thinks your complaint is in your head (duh) or is in some way not treating you with the dignity and respect that your insurance dollars demand of them… stand up and say something! You do not always need to be nice. Trust me on this one.

I learned long ago to hide much of my mental crappiness that was going on in my skull. I was super high functioning. I had kids to raise. I can play the “I’m fine, I’m a great” parent game.

But you know what? Turns out that didn’t help the “me” of today. The “me” of today STILL needs something for anxiety. Go ahead moron. Yes, you Jamie, you have ignored my pleas for something to do for me what all the hundreds of hours of counseling have been unable to do… relieve my over the top anxiety.

I’ve asked this woman for something for anxiety since the first time I saw her. You know what she did? She started lowering my Clonazapam (spelling). Every time I’ve seen her, she reduces it. “It is just one less pill. You’ll be okay.” [bitch]

I went home with 10 pills for 30 days.

She increased my Ritalin dosage and made it extended length. I didn’t ask for that. What? You want me to calm down so we can finish our 20 minutes on time? Have you dosed me so that I’ll be a good woman and let you get done with me?

Well guess what? The shits hitting this fan.

Can any of you relate? Have you felt unheard and improperly treated? Guess what? You are NOT ALONE. Not by a screaming momma long shot.

I have IBSd. I had to talk to my counselor from home. Since I was in my own I felt FREE to explain again about my anxiety and graduation and jobs and money and acting out in class because I simply cannot contain the mountain of anxiety spilling … over into my phone call.

For an hour I yelled about Jamie to my poor counselor. I accused her of having her own agenda and it didn’t include my mental health. I’m done. She either treats my anxiety when I see her next week or –

Or I will hand deliver a letter I’ve been writing about our times together to the facility director. I’m done.

I’ve worked my hardest, trying to keep hold of myself while my wild mood swings tried to prevent me from my goal – getting a college degree at 55.

This, this Jamie, she can’t seem to hear, see, understand, empathize or give a rats ass whether I self-destruct because my anxiety has paralyzed me again. I sit on the sofa and I cry because I’m terrified I’ll fail. So I don’t start. Then the panick sets in as I realize I can’t write the paper.

In the name of the oath that we have been lead to believe that those in the medical profession must swear to, treat me for my illness.

I cannot imagine going through the graduation ceremony in the Tacoma Dome with my freaking anxiety not treated.

I cannot imagine the day after graduation when I need to be looking for a job, but because Jamie didn’t treat my well documented illness I am instead sitting in the back yard vegetable garden pretending to being weeding. The problem with this scenario is that I have arthritis, and if I have sat in the garden without anyone home to help me up… I’m not going to getup. It would mean that I’d given up. It would mean that I’d be punishing myself for continuing to be the Bipolar failure that I’ve always been. (How I feel.)

And Jamie? Still with me? You could have prevented me from losing all the ground I’d worked so damn hard all these years to reach. And why? For what? From here it just seems you’re stupid. Some medical “professionals” are stupid you know. I’ve even taken my counselor with me on two occasions to verify what I tell her.

I’m done.

I’m saying Hell No! That’s enough of this irresponsible crap. You expect those of us with mental health issues to behave? Then treat us right. Hear us when we call for help. If we bring backup pay special attention. I’m trying to get my son to go with me. He’s a psychology major.

To all of you struggling to work with your own Jamie’s, you stand fast. Do not let them push you around. They’re there to serve your medical needs. Document what you talk about and when. Keep a clear record so if you need a new med provider you can state your case and prove that they aren’t listening.

One reminder though. If you’re really messed up you may not be thinking straight. No worries. You just take a family member or someone who you can trust with you.

You’re not alone.

Oh, and if you happen to be a Jamie, what’s your damn excuse?