treating mania ...
Although it is clear that my bipolar manifested in college, it wasn't till I was age 49 that I sought help. I was misdiagnosed with unipolar depression and prescribed an antidepressant which had me bouncing off the walls. Of all things, florid mania proved to be much safer than the suicidal depression I had been in. Ironically, bad psychiatry may have saved my life.
But that same psychiatrist also did something right, for which I am eternally grateful. The second time out, he put me on a low dose mood stabilizer (initially with an antidepressant). He didn't overmedicate me or turn me into a zombie. Yes, my thinking was slightly slowed down and my emotions were a bit blunted, but my brain had been running too hard and too fast and too unreliably, even in neutral. Slightly slow and blunted was good. Soon, I was on my way to a new career in mental health journalism.
Years later, purely by accident, I went to a half dose, ironically when the psychiatrist I was seeing at the time wanted to double it. That doctor, with no inquiry into how I was actually managing my life, simply saw that my dose was about one half of what his patients were receiving. With each successive visit (thankfully three months apart), his hints grew stronger and darker. Always, he framed his hints in terms of "him" putting me on a higher dose, as if my actual situation had nothing to do with it.
Depression was far and away my main issue, not mania. But my doctor showed little concern about how I was faring with this side of my illness.
Then, my health coverage ended, and I requested a switch to a cheaper generic version of the same mood stabilizer. This meant keeping track of four pills a day, which proved impossible. It wasn't long before the rest of my thinking came back on line, along with the rest of my emotions. Trust me, it felt wonderful having all my brain back, but could I manage the extra amplitude?
Over the years, I had picked up a broad range of recovery and coping skills, such as maintaining a strict sleep routine. Looking back, I realized I had only experienced two full-blown manic episodes in my life. The first, back in the eighties, came from a crazy work routine involving very little sleep. The second, years later, was triggered by an antidepressant. Obviously, my chances of mania were remote.
But what about managing the extra amplitude? Would my brain cooperate with me when I needed to focus on my work? Would I have dominion over my emotions when I found myself in a challenging social situation? Would I continue to enjoy my present peace of mind, or would I be spending most of my waking hours in a state of agitation?
It wasn't an all-or-nothing decision. I could always bump my dose back up, I realized. I could always go back to the more expensive one-a-day pill. So, I made my choice: High dose recovery, low dose med.
I didn't consult my doctor. Or, rather, my doctor never would have consulted me. Here I was, a mental health writer advising fellow patients to forge trusting relationships with their clinicians, going behind my doctor's back. It was clear I would have to fire my current doctor and find a new one. A year later, I booked an appointment with a new doctor. But then my life intervened. Next thing, I was on my way to California, where - eventually - I did find a doctor who actually listened to me.
I will be the first to acknowledge that managing the extra amplitude can be a challenge. Often I have to deal with emotions I don't want to deal with, but that is the point. Back when I was on a higher dose, I did not experience the same range of emotions the rest of the world did over the tragedy of 9/11. I needed to cry, if not real tears, then full-strength cathartic psychic ones. Yes, on a higher dose I was comforted by the thought that I could venture out in public without Crazy John showing up. But my daughter quickly picked up on the fact that the delightfully wacky side of my personality - one that played such a central role in the unique bond we had forged over the course her life - was missing.
My wacky side is back, much to the simultaneous delight and consternation of people I deal with. It is a legitimate part of who I am. Meds are not meant to medicate personality out of people, and heaven help if they ever came up with one that did. But earlier in my recovery, my leave of absence from this side of my identity was a very small price to pay to manage an illness I could not have otherwise managed. I consider myself very lucky.