Showing posts with label Recovery. Show all posts
Showing posts with label Recovery. Show all posts

Temazepam

Since my 10-day hospitalization for mania, which ended in April, my psychiatrist has made adjustments to my combination of medications. I am now taking 1350 mg. lithium carbonate ER at night, 5 mg. of Saphris in the morning and 5 mg. of Saphris at night, 200 mg. of Lamictal in the morning, and 15 to 30 mg. of temazepam at bedtime, as needed, for sleep.

I just took my first dose of temazepam for sleep last night and I feel good today. I slept well, I did not have a medication hangover when I woke up, and I have been calm and productive all day. I'm thankful that my psychiatrist prescribed it, and I'm hoping that this will complete the perfect combination of medications for me. If it works, it will be the combination I have been hoping for for the past 23 years - one that lets me feel and act like my best self.

My former psychiatrist switched me from temazepam to Ambien about 7 years ago because, he said, Ambien was less likely to be habit forming. That didn't make sense to me, as I hadn't formed a habit, but he insisted that I needed to make the change, so I did, and I haven't experienced as much stability since then as I did before he made the switch.

I told my current psychiatrist what happened when I was switched from temazepam to Ambien, and she wrote a prescription for temazepam right away. Anyone who has bipolar disorder knows how important sleep is to managing the health condition. Some doctors avoid prescribing sleep medications, because they may be habit forming, and instead use other medications, like the antipsychotic Seroquel, for example. I tried to use Seroquel for sleep, but I felt very much impaired and overly sedated during the day. I made many more mistakes than usual, and always felt like I was ready for a nap. I'm happy that my current psychiatrist sees me as a unique individual and prescribes the medications that work best for me.

Many mental health bloggers shy away from writing about the medications that they take, but I don't. I've always been told, and I've learned through life experience, that medication is necessary for managing bipolar disorder, especially Bipolar Disorder I, the most severe form, and the one that I happen to have. Since I'm sharing everything else I do to maintain balance, and since medication is so important for that, I'm describing the medication that I take, and how my psychiatrist decides to prescribe it. She only likes to change one medication at a time, so she can evaluate how each one works in combination with my other medications. This can be a laborious process, but I feel that it is helping me to experience more wellness.

Every person who takes medication is a different person with a different lifestyle. There is no one size fits all in psychiatry - at least there shouldn't be. I'm not suggesting my exact cocktail of medications to anyone else, I'm just writing that it is what's currently working for me. Reading stories of recovery, including stories of people finding medications that work, has always given me hope. More than anything else, in writing this blog, I want to encourage anyone with a mental illness, as well as their friends and relatives, to hang on to hope.

A Break from Reality

In March, I was having trouble with my boyfriend. We were arguing a lot about what I considered to be very small things. Then, after a sudden betrayal of my trust, I broke up with him and didn't look back. Also, at work, I was facing some moderate stress. In addition, the season was changing from winter to spring. I often become hypomanic when the days grow longer and the temperatures start climbing. I felt like I was speeding up, but I was still sleeping, though, as I now recollect, not very much. I had made a promise to my psychiatrist that I would call her if I started missing sleep. I wasn't exactly missing sleep, but I was racing through my days and not sleeping as many hours as usual. I had things to be upset about, but I felt good anyway. Maybe it would be better to describe it as energized. I was enjoying the sunny weather, and I felt productive - likely more than I really was. It's hard to describe this time accurately, because I was moving through it in a blur. It was almost dreamlike. As I look back now, I am sure I was hypomanic.

The day after I broke up with my boyfriend, the owner of my company, as well as the president, came to ask me questions about my breakup, my work, and my mood changes. They said they had noticed that I was acting different (hypomanic). They had seen it before, a couple of years past. At the end of our discussion, they told me that they would be giving me paid leave for as long as I needed it to "get healthy". I knew that I was hypomanic, but I was still sleeping (for the most part). My parents had plans to go visit my sister in Connecticut the next day. It seemed like the perfect opportunity to see my sister and nephews and rest. I felt like all I needed was rest, and then my hypomania would subside. So, I left, with my parents, for Connecticut, the next day.

As it turned out, when I got to Connecticut, I didn't rest. I barely slept at all. I woke up before everyone else, at the crack of dawn, and would quickly put on my clothes and start walking to the town center and all around the town. I would come back around noon and meet my family for lunch. They left the back door open for me. I think I probably walked at least 5 miles each day and some days I think I walked about 7 miles. I would describe my walking as roaming and exploring.

Everyone in my sister's town seemed extremely friendly, and they greeted me warmly. It's a small town, so I'm sure that many people knew that I didn't live there. The highlight of my time there, was the first morning, when my sister and I went for a walk on a beautiful beach near her house, but I spent most of my walking time by myself. I would first walk to Starbucks, the earliest place to open, and I would talk to the people there who were getting coffee before work. Everyone in the town seemed so kind. When I looked at their expressions, I felt like they were sending me secret messages. I felt really welcomed, loved, and taken care of. It was beautiful, but I know I was imagining a lot of what was going on.

We went to the Easter service at my sister's church the day before I was supposed to fly home. While I was in church, my mother, who was sitting behind me, grabbed my purse and moved it. I was extremely irritated by this, as I didn't understand why she had disturbed me. So, in the beginning of the service, I reprimanded her, not quite yelling, but speaking to her loudly and harshly. I then quietly walked out of the church and started walking around town again. I went back to Starbucks, and, surprisingly to me, because it was Easter Sunday, it was crowded. After I drank a couple of iced herbal teas, I began wandering again.

After church, my parents called me. I agreed to walk back to my sister's house and then we went to a special Easter Sunday Brunch at a nice restaurant. After the church incident, I was on edge whenever I had to deal with my mother. We were supposed to fly home the next day. I was becoming increasingly agitated and upset. A couple of hours before we had to fly home I realized that I was going to lose it on the plane if I had to fly back home. I asked to go to a hospital. A few minutes later, my sister drove me to Yale-New Haven Psychiatric Hospital where I was admitted because of my manic behavior and my delusions of people psychically communicating with me.

When I arrived in the psychiatric emergency room, it was discovered that although my lithium level was low, I had lithium toxicity. The reason my lithium level was low, is that the lithium toxicity was causing extreme thirst, and I was drinking huge amounts of  water to quench it. Because of this, lithium was being washed out of my system. So, I was put on water restriction for 24 hours and when my lithium level was taken again, it was toxic, because I hadn't been allowed to drink nearly as much water as I had been drinking before.

The psychiatrist in the emergency room explained that I would have to take less lithium, or even no lithium, and add an antipsychotic medication to prevent further episodes of mania. When I got out of the emergency room, where I stayed for three days, I was admitted to the psychiatric hospital, where I stayed for seven days. The psychiatrist in the hospital decided to lower my lithium dose from 1800 mg. to 1350 mg. He then ramped me up to 400 mg. of Seroquel and kept me on 200 mg. of Lamictal. I felt better and better each day.

When I was in the Yale-New Haven Psychiatric Hospital, I received the best care that I have ever received in a mental hospital. It was such a relief to be listened to and taken seriously as a human being. I had been complaining of my extreme thirst for about two years, including another time when I was hospitalized in Kentucky. My complaints were always dismissed, even though I had measured how much I was drinking each day. I told three doctors about this, and I told them I was drinking about eight quarts of water every day, and they just told me that nobody knows how much water an individual needs, so I should just drink when I was thirsty.

When I explained this treatment to a nurse at Yale-New Haven, he became incensed and yelled, "What are they, retarded? Nobody should be drinking eight quarts of water a day. You could have died! Your organs were failing!" All I can say, is that is the difference between mental health care in Kentucky and Connecticut. The only person in Kentucky who noticed my extreme dry mouth and irritated tongue was my dentist, and she considered it to be a problem worth addressing, so she gave me some special mouth spray to use (Biotene). It did help my mouth, but it didn't take away my thirst. I just told her that my doctors had advised me to drink whenever I was thirsty, and I was doing so, but my mouth was always dry anyway. Doctors in Kentucky don't believe you when you say you're drinking eight quarts of water a day, but your mouth is still parched. In Connecticut, it is considered (correctly) to be a medical problem.

I love Kentucky, but if I ever have a serious medical problem again, I'm going to Connecticut for a second opinion. Kentucky is not known for its brainpower. We are among the least educated states in the country. There are many reasons why people choose to live here anyway, but one of them, is that if you are educated, it's much easier to get a job here than places where there is more competition. I've always considered Kentucky to be a backward state, but I have grown used to it, and have had many good experiences here anyway, and have made many good friends whose companionship I treasure, but I often feel that if I hadn't been stricken with a severe and persistent mental illness, I would have left right after high school and never come back.

Recovery

From 2002 through 2007, I experienced the longest stretch of recovery that I have experienced since I was diagnosed with bipolar disorder in 1989. I believe that  this recovery came about as a result of the medications I was taking and the ways I was trying to improve my life, but I wasn't focused on it, it just happened.

In 2002 I went through an upsetting breakup. Afterward, I decided  to put my energy into my work, my education, and my friendships. I wasn't thinking in terms of preventing a relapse of bipolar disorder at all, but I ended up concentrating my efforts into some areas of my life that contributed to my wellness.

Although I had been compliant with my treatment for bipolar disorder for many years, I still had not fully accepted my diagnosis. I secretly hoped that I would grow out of it, or it would just disappear. By 2005, I had earned a Master of Arts in Teaching and had been teaching for almost two years. At that point, it seemed like I had my life under control, so I asked my psychiatrist to make some changes to my medication because of some side effects I was bothered by. In hindsight, I realize that this wasn't the best idea, because the changes increased the likelihood that I would become unstable. That is how psychiatry works though. Everything is done through trial and error, because the brain and its disorders are still poorly understood.

Teaching was my life and my life was becoming more and more unbalanced. I was putting all of my energy into work. The hours I worked,  as well as the sedation caused by my medication, made it very difficult for me to exercise, something that has always contributed to my wellness. When I got home at the end of the day, I was exhausted and rarely ate anything more nutritious than a microwave dinner. I spent most nights preparing for my next day at school and then reading until I fell asleep. I spent less and less time with my friends. My students and coworkers brought me joy, and that sustained me for a while, although my life away from school was taking a steady downturn.

In 2006 I found out that I had developed workplace-related asthma because toxic black mold was growing in my classroom. My allergist advised me to transfer to another school because he felt that it was unlikely that my school would clean up the problem anytime soon. I took his advice and transferred to a new school in 2007. My health habits had been slipping while I worked at my old school, but when I entered my new environment, where I didn't know anyone, and was also an unknown, I quickly fell into a deep depression. My classroom was immaculate, and my asthma disappeared, but I was overwhelmed, became unable to work, went through shock therapy, and qualified for Social Security Disability. Everything I had worked for seemed to slip away so quickly. It was the biggest wake-up call I have ever experienced.

Ironically, becoming disabled has enabled me to focus on my wellness. I think my problem with recovery in the past is that I just tried to forge ahead, without properly acknowledging and respecting my disorder. I have bipolar disorder and I can never forget that. I have given up the hope that it will ever disappear and have become vigilant about staying well. So few people, without the condition, understand the discipline it takes to live well with bipolar disorder. Things that are no big deal for many people, like staying up all night, or getting drunk, can lead to rapid mood changes, serious depression or mania, and the need for immediate psychiatric intervention, including hospitalization, for people with bipolar disorder.

Twenty three years after my diagnosis, I finally understand all that it takes for me to stay well. I have gone through a great deal of trial and error with medication, therapy, support groups, relationships, work, exercise, diet, and more. I have seen attitudes toward mental illness change in the years since I was diagnosed, and I think if there were as much acceptance when I was diagnosed as there is now, it wouldn't have taken me as long to reach my current level of recovery. My hope for myself is that I will be able to stay on the path of recovery, and my hope for others is that attitudes toward those with mental illness will continue to improve so that it will be easier for those who need help to get it. I also hope that more research will lead to a better understanding of all mental illnesses and also to better treatments, with fewer side effects, for those who are affected.