Read Part 1 here and Part 2 here.
So I started going off my medications. Depending on the medicine and
what it was used for (anti-depressant, mood stabilizer, etc), I went
down a percentage of one medication's full strength every 10 days. My
doctor wrote a little chart out so I could keep track of a very long term plan. It's tricky business. We had to factor in which would be most important for me to stay on for the longest time (the last one I would go off) and which would be the least important (all relative, but the first I would attempt to go off).
I was really excited for what all of this would mean- getting to try to have a baby. But other than that, I was so not looking forward to this. I hadn't been without medications since I was 17 or 18 - around the time I first got diagnosed with Major Depression. The years spent figuring out what medications would work... well, let's just say those are top contenders for the worst years of my life. I would go back through middle school again before repeating my early 20s. (Hint: I hated middle school. Aside: did anyone have a good experience in middle school?) When I finally found medications that were working and holding strong, I was not so ready to give it all back up.
This was an arduous process. It was also enlightening. Let me explain. The diagnosis of Bipolar Disorder itself is hard enough to come by. Psychiatric medications (or "head meds," as I affectionately call them) take an incredibly long time to start working. It takes roughly 6 to 8 weeks to start working and even longer for them to reach their full potential. I remember my dad asking me once, when I was just totally and completely in the middle of a breakdown I was having years ago, "don't they have anything they can give you now?" Unfortunately, no. There is no instant fix - and we all wish there was one. Medications can also plateau. They rise up over the weeks, and then simply reach their full potential. For some people, that can be after months or even years of working out great. It's also not a simple answer of dosage. Most doctors have the goal (a great one) of wanting you to be on the fewest number of meds at the lowest possible dose. Over medicating can be problematic for many reasons, but one of them being that it is often when patients start complaining that the medicine is over-riding their personality. Would you want that? To feel numb? Trust me, it's not good.
Bipolar disorder is so tricky- there are very few of us who are really okay with being on only one medication. That's another thing that stinks. Four turned out to be my magic number before I went off of everything. Two was the lowest combination, and I think six may have been my highest. I was on a mood stabilizer, anti-anxiety medication, antidepressant, and a slightly different mood stabilizer. I wish I could tell you more about the chemistry of how they all work, but that is currently beyond my grasp. The goal of a mood stabilizer (besides the obvious name), is to set the patient on an even keel. This is incredibly difficult to do- there are medicines to bring my depression up, to settle me down, but an attempt to keep me even, from going either up or down, without making me the most boring person on the planet- I find that impressive. But a mood stabilizer, as simplistic as the name sounds, will not usually work on its own. I am more inclined towards depression, less toward manic episodes, so the antidepressant is key for me. I also have a problem with anxiety- those tiny little 5 milligrams (very small pill!) made me feel normal once again.
So what do those last two paragraphs have to do with going off the medications? Or going on them? I'm sorry, but this is such a huge topic. I'm doing my best to be concise. Again, if you feel like I've skipped over anything, leave me a line in the comments. I'll do my best to address it in a post, follow up comment, or email, if that's what you prefer.
When you are a Bipolar patient, you and your doctor are trying to address immediate needs with medications that don't work in an immediate fashion. You want to feel better today, now. But it's not so easy. So your doctor puts you on M. M takes 6 weeks to work, but you find out that it gives you a horrible side effect- your skin turns purple (totally made up, never happened to me). Yikes. You get taken off M. You go on N. N is pretty good. It takes a while and eventually stops the mania. Sweet. But you find you are more succeptible to depression after say, 12 weeks. So you go on O, an antidepressant. Whoops, you sleep 15 hours out of the day. But it's really great and you feel really great, so you tell the doc, I can live with this. N starts to slip. It's just not progressing. But you tolerate it well, so doc adds another. P. Oddly enough P makes you unable to, well, pee (true story, happened to me, didn't pee for 48 hours). Doc freaks out and takes you off of it immediately. Q works well and you start to feel better. All of this, this on and off, takes you maybe 28 weeks. This is way oversimplified. I've lost count of the number of meds I have tried over the years. It's well past 30, I can tell you that for sure. And you're never truly done. I constantly go in for updates. I'm not even on medications now, and I see my psychiatrist every 8 weeks.
In the middle of all of this, you battle incessant side effects. It's insane. Here are just a few of mine: too much sleep, not being able to sleep, racing thoughts, dry mouth, the aforementioned true story that I won't repeat, hair loss, weight gain, weight loss, general fatigue, and so many other things. But you can't really drop a medication once you get a weird side effect. Sometimes you just deal. I dealt with weight loss and trouble sleeping for a long time. I was seriously thin- 117 pounds and 5'9". Then there was the time in college I gained 30 lbs in 4 months. I did not like that. But being way bigger or way smaller? Sometimes it's worth it, just to get your brain to feel normal for a while. Or the medication where I took a nap 6 out of 7 days a week. I did what I had to do. So losing some of the side effects was nice. But I have to take Benadryl every night because I was on a medicine that made me sleepy for so long, my body no longer knows how to put itself to sleep at night. Haha, oh well.
It is usually easy to determine what medicine particular side effects are attached to. But it's much harder, in the midst of rapid medication changes, to determine what exactly your medications are controlling in your brain. When I went off that first medication, a more minor mood stabilizer, boy I could feel it. I knew exactly how my brain was acting differently! It is gradual when you go on a head med and then mixed with other medications, it can be hard to pin point exactly what changes. As I pulled off the antidepressant next, I knew exactly what it was doing, and so on and so forth. In the jumble of commotions, side effects, and problems, going on medications can be hard. But the clarity I received in going off of them... I just think it's invaluable and as I said before, enlightening.
I was trying to explain this to my therapist and she asked if I would want to stay off of them permanently (given how well, overall, I have been doing). I was very quick to set her straight! When the time is right or needed, I will want to go back on my medications. However, I will be sure to be very clear about dosage (to be on the minimal amount) and also to, if at all possible, go on them slowly. I strive to be a good patient and be conscientious about what I put in my body and, to the best of my abilities, how it works.
I think it's a very hard line to walk, as doctors and patients. Doctors try to get you on something that will work, but every body processes things differently- different side effects, different symptoms, different timelines, different tolerances. It's not easy. They're not flying blind, but just cautiously, in one of the trickiest areas of the body, sometimes in fields with very little research. Remember my little protest for more studies in pregnant Bipolar women? I trust my doctor implicitly. I fully recognize how hard his job is. As patients, and sometimes as a nation, we raise up against the over-medication of people. We are afraid of too much or not getting enough. As someone who has been through years of this, I understand where both sides come from. Hopefully this helps you understand a little more too. Perhaps our next rally could be for further research into not only Bipolar Disorder, but all psychiatric disorders and developments. And also, pushing for constant monitoring and development of medications and treatments. Just saying... :)
The big disclaimer: do not self
medicate or self diagnose or self impose any changes to your medications
or plan of treatment if you have BPD, just because you read something
here. For the same reasons that I don't give out the names of my
medications, I can't advise that this plan will work for anyone else. My
doctor, my body, my weird brain. Talk to your doctor about the best
plan if you're Bipolar, plan on becoming pregnant or are already
pregnant. I think I'll just add this to the sidebar.
Thanks to everyone who stuck through this little series with me. I may add more later, but for now, I hope this helps you see my journey. Keep asking questions and giving me feedback. I appreciate it.