Drugs

06Mar09

When you’re in a mental hospital, people take exception to the use of the term, “funny farm” as degrading and offensive. Yet, they use the term psycho-pharm all the time. For those of you who don’t know, a psychopharm is a psychopharmacologist, i.e. the person in charge of the drugs you put in your system to try to regulate things like in my case, mood.

I have a holy triumvirate of drugs; Abilify, Lamictral, and Levothyroxine. Now, the Abilify is supposed to put a cap on the manic sort of episodes. Having a fairly recent mixed manic episode, it’s a good thing. It’s also a temporary thing. Once we get the Lamictral to a totally therapeutic dose, we’ll get me off the Abilify.

Don’t you just love the use of the word “we”, as if the psycho-pharm is doing the same drugs and having the same experiences. I’m the one taking the drugs. I’m the one suffering through the side effects, dealing with the mixed mania, etc. Where’s the “we” in all of this?

Anyway, since my primary polarity in my bipolar disease is depression, I’m on Lamictral. That’s supposed to stablize my overall mood, and help with the depressive side more successfully than other mood stabilizers. Lamictral effects my eyes, so for a week or so, my vision really sucks, then it gets gradually better. Nonetheless, I still have drug induced vision problems that force me to wear glasses to see really clearly. So far? I’ve actually had a few good weeks before sliding down into another depression. So, up the dose.
Then there’s the Levothyroxine. Synthroid. Whatever you want to call the synthetic thyroid hormone. One of the symptoms of hypothyroidism (not enough thyroid hormone) is depression. Yeah, cool. My recent test indicated a TSH (Thyroid stimulating hormone, a hormone produced by the pituitary to get the thyroid to produce more t4 thyroid hormone)twice the maximum normal level. So, up my dose there. Interestingly, there’s a significant correlation between thyroid disease and bipolar disorder. Anyway, I’m depressed, and from two angles.

Now, it’s just a matter of waiting for the effects of the new drug doses. That’s just always so much fun. But, it does creep up on you. One day, you’re miserable, the next? Maybe a hint not so miserable. Then, you’re trudging through life and realizing, hey, I’m having a good day. Then they string together, as long as the drugs are effective. That doesn’t mean that you don’t experience the emotional side of life – there are thing sthat make me down, that irritate the hell out of me, that make me laugh, that give me great joy, but those things are related to things that go on in my life. They are usually caused by something. They aren’t so extreme as to be something unmanageable. It’s good.  It’s the waiting that’s hard.

Drugs change.  First, you have to realize what you’re dealing with.  Initially, I went on an SSRI to deal with depression.  SSRIs can mess with thyroid function, and that’s exactly what happened with me.  I traded one depression for another.  Then, we went to Remeron.  That unleashed the manic beast and the best time I’ve ever had pulling all the muscles in my body.  Now, I never went psychotic, per se, but I was totally out of control and in a hospital to manage things.  That hospital let me climb the walls and run around as much as I wanted to, lecture on anything I wanted to, prattle on and on and on in a quick, highly pressured way jumping from one association to another in a manner that made total sense to me at the time.  Anyway, the hospital folks let me do that – push ups as long as they kept my attention, 8 hours of running even though I’m not a runner, whatever, as long as I wasn’t a direct danger to myself or others.  It was great.  Lasted about 4-5 days and was one of the best times I’ve ever had.  That’s a true manic episode.

Mixed mania is not like that.  It sucks.  It’s having racing thoughts, too much energy, and not being able to enjoy it.  Matter of fact, it is anything but enjoyable.  Yes, there’s a surplus of energy, but it’s offensive rather than fun.  There’s a fair amount of feeling worthless and depressed, but too much irritable energy to do nothing.  It’s like that restless lion pacing in a cage.  I’ve had at least two of these episodes without the Remeron.

So, back to the drugs story.  The day I went manic on Remeron was my last day of Remeron.  I was placed on Depakote to stabilize my mood.  Depakote is primarily used for seizures, but it has a mood stabilizing component, so it gets used a lot for bipolar disorder.  They got me to a therapeutic dose, which means it ameliorated my symptoms of bipolar and left me just a bit depressed.  Problem was, I also got muscle cramps in strange muscle groups, like my abdomen, neck, and butt.  The butt cramps were the most fun – I’d be driving along and boom, a butt cramp of the magnitude never experienced before, and I’d be on the side of the road beating my own ass trying to get some relief.

That was the end of Depakote.  Now, lamictal.  We’re still seeing how that goes, but it shows some promise early.  This is where there’s art, not a lot of science to the whole thing.  Yes, the scientific method plays a role – one drug, if it doesn’t work,  drug.  If there are terrible side effects, next drug.  That’s kept up until we find one that works.  All the while, you are praying that you find one that works and you don’t have to live with full blown bipolar for the rest of your life as there is a small percentage of people for whom drugs don’t work.  Lamictal, baby, let’s hope it’s my miracle cure.

The practice of law is difficult if not impossible at these times.  When you’re at the extremes, it is totally impossible, even thought I feel like I can manage.  Depressed, I can muddle through somehow.  Manic, I come up with the greatest out of the box theories of the case and motions in limine.  The practice of law at these points is the recognition that you can’t properly serve your clients in this state and that hospitalization may be in order.  The practice of law is the non practice of law, and the preservation of the client in tact.  It’s finding partners and other lawyers to cover or take over your cases.  It’s the courts understanding that time is needed, that the client comes first, but the lawyer also needs support.  But we never talk about these things.  I just disappeared.  I passed off all my clients, closed up shop and disappeared.  Nobody has asked questions.

Filed under: drugs and other pharmacological events, Uncategorized   |  Leave a Comment
Tags: Abilify, attorney, Depakote, depression, drugs, Lamictal, law, Levothyroxine, Mania, psychopharmacology, Remeron