Taking Medication,
Take Two

continued

16 May 98 - Diary
Staying up was a bad idea, though it may have been my only choice. Took medication at 6:00 am, at 7:00 onset symptoms started appearing - nervousness in writing or fine motor movement, my "excited" feeling, my anxiety about what to do next. Ended up at my favorite coffeehouse at 7:30 am feeling panicky. Called my sister-in-law to calm me down. This worked.

However, I didn't get any sleep - am now sleep deprived. Will muddle through Saturday night, but Sunday is going to be a mess. I am seriously considering giving up going to the prayer function I have been invited to in return for a sleep filled day. Think I will make excuses later. Thank god I can be at home by 11:00 am tonight. Will aim for waking up at 6:00 am in the morning. Too late is not good. Today was certainly manic, but it was triggered - out of the usual cycle. Nevertheless.

17 May 98 - Diary
Went to bed at 11:15 last night. Wake up early this morning, which was good, my normal cycle kicking into gear. Had parents over for breakfast, then fed my neighbor breakfast. Went down to my cousin's farm with the intention to going to Princes Town.

Started feeling tired - the type that kicks in. I think it was an echo of no sleep from Saturday. Am worried about deprivation very much - it sees to trigger cycles. But going to sleep early wreaks havoc with my night life.

Decided to forego the prayer function and slept for two hours by my cousin. Was lucid and normal for the rest of the time except when I was talking and I realized I was butting in on the conversation. Looked at my watch and it was nearly two hours past the time for my medication. A warning, the cycling doesn't go away, it is just kept in abeyance.

Got back home started doing little things wrong. Was scared - is this mania? Is this the start of my depressive cycle? Is it tiredness. Finally am going to bed. Dishes are still in sink, a big no-no. We'll see what happens tomorrow morning.

18 May 98 - Diary
Today wasn't bad. But by 6:00 pm was stressed out. Trying to change, friends visiting, C. calling. Finally gave in and took 100 mg Tegretol. Got calm and will remain so for the rest of the night. Question - am I manic, or stressed out normal, or normal with a stress trigger, or just mildly manic?

19 May 98 - Diary
Had a weird day. In work had a lot of disparate things to do. Did them all but had a jumpy feeling that I associate with mild mania. My secretary noticed the external symptoms. Wanted to go home and sleep after lunch but couldn't due to requirements at work. In short an acceptable day, but not the type I want to live.

Had friends over. Was witty etc., not exactly calm. Feels like my old behaviour. I don't like this feeling really, but it feels good. The intellectual versus the emotional. How can I keep the best of both worlds?

As I told my psych, the mania is worse than the depression…unpredictable. I hope that it stops soon. I'm not sure how long again I can be in control.

20 May 98 - Diary
[Note in very scrappy handwriting]
Since three this afternoon I've been triggering into a full depressive mode. The Tegretol helps, but not completely and only for about four hours. I'm going straight from mild mania to fairly bad depression (or mania) - no stable position between. This is being written with all the discipline I have. Details are dropping out. Help! All basic support systems are failing and I am not having enough sleep. Now, I'm drunk too.

21 May 98 - Diary
Today was worse than yesterday in terms of control. Basic subsystems failed mostly, but was able to get out of the house. Before I left the house, I showed signs of depression, but for the rest of the day I was manic. Functional, but in less control than before.

I think that 600 mg Tegretol alone is too low. A lot of the day spent dealing with mania symptoms - loss of motor control, inability to choose what to do. Bloody annoying. Saw my psych today. Am going on Lithium as of tomorrow (400 mg Tegretol, 600 mg Lithium). I expect myself to destabilize over the next three weeks before the Lithium kicks in.

22 May 98 - Diary
Today was good. I would call it normal, but I have a feeling that I was in shock. My psych's comment that what I call hyperstable is probably normal has had me in shock. I cannot believe that I could achieve that, which would be nirvana.

Or that what I have lived with, in a mad mad world, is so far from being normal. The wonder of what normal could be, that calmness, just stuns me.

The fear that I may never reach there has me terrified. Calmness is being held out and I am so afraid I may stumble before I can reach it, that I may never reach it.

I can now watch what I have lived with in perspective and feel some hate - I despise that I have had to live like that for years. I hate feeling like that.

If this all fails, if I have to return to living like that - well read Flowers for Algernon.

Addendum - I am starting to get the twitchiness and being pulled into stuff and loss of concentration that "I" associate with my normal. Took 400 mg Tegretol, 300 mg Lithium this morning. I'm really going to catch hell over the next two weeks as the Tegretol level in my body subsides.

27 May 98 - Diary
Saturday (23rd) to today (27th) have been difficult to deal with. I progressively destabilized.

On Saturday I got up, got started well and then was unable to follow through. Instead of going for groceries, I sat at home and read. Tried a few times to jump start again, but was derailed each time by reading, by the computer, etc. No anxiety this time, because I know when this happens, I should just ride it.

Started looking at the clock. I had to pick up a few people and began to time it to the absolute instant that I could stay in the house before leaving to pick them up. When I did leave, drove very fast, playing music really really loudly. The perfect sign for hypomania. Was considered one of the good people in the group, singing and making jokes. Went to bed late, at 1:00 pm. Missed taking medication at 6:00 pm because I was feeling too good. Eventually took it at 11:00 pm.

On Sunday I got up at 9:00 am, really disoriented. Had that feeling of mania hanging over me. Was able to go to the grocery in preparation for the Scrabble Club meeting by me, and by focusing on that I did well. Taking the Tegretol allowed me 3-4 hours of peace as well. By mid-afternoon, things started going screwy. I was unable to remember what I wanted to do next, and my speech was becoming difficult as I couldn't remember what to say next. C. was there and we were able to handle things for Scrabble. That is, C. was able to have things ready, I was mostly reading. I was loud and obnoxious at Scrabble. And I couldn't figure out how to make words. And was insensitive. By the time people left, I was terrified about what was happening.

I knew this was where I had been, and having spent about six weeks more of less stable, I didn't want to be there any more.

Monday I realized that I couldn't make it out to work. Called in sick. Spent the entire day reading or on the computer. The outside world didn't feel real. Missed gong by my cousin even though I had promised her to pass by and missed dinner by an aunt. Slept a lot…was in bed by 7:00 pm.

On Tuesday C. called me for exercise at 4:30 am. Made it, did the exercise, returned home feeling well. Was able to make it to my 9:00 am meeting and to work after. Was still feeling a bit jumpy so I went home at 1:00 pm. Somewhere at 3:00 pm, I realized that I was calm. No compulsions…just gone. Can't figure out why. Exercise? Lithium kicking in? Cycle at normal point? I don't know.

On Wednesday I got up early without difficulty - a sign I associate with stability. The remainder of the day was fine. Didn't eat until 3:00 pm but felt great all day.

28 May 98 - Diary
Today was a great day. Got up without a fuss, went gym and worked out (drank 2 liters of water). Morning schedule operating smoothly. Nothing was fussed, though there were periods that I would usually have become confused and lost my ability to concentrate.

Productive, little or no wasted time. Unusual when doing computer work. Stayed until 5:00 pm to finish work. Again, I was surprised how easy it was to keep doing real work after everyone left instead of puttering around the way I usually would. Came home, had dinner peaceably.

Schedules are still out of wonk, but that's ok. Am actually looking forward to a time when I can live "symptom free." However there are one or two signs I didn't like. Either they never went away or they are coming back - my inability to remember words / finish sentences, and easily distracted by wandering thoughts has not gone away.

17 June 98 - Diary
Well, missed days are missed days. And it is unreasonable to expect a rapid cycler to have a consistent notebook. Am on the way out (almost out) of a depressive cycle that started on the 10/11 June.

Will be phasing out the Tegretol over the next ten days to see if the Lithium alone works. Serum measurement puts me in the therapeutic range, and I am better, but the cycles continue. If anything, I'll go to Valproic Acid (Epilim, Depakote).

Now that I have to look forward, I wonder what will happen. The mania / depression are now never bad, but they happen so quickly that they are disruptive (they have always been disruptive).

How can I be reliable or take on a long term job if I can't predict my state of mind / being over the next two weeks. This really throws into question the type of work I can handle. It upsets me, because intelligence hasn't changed.

I fear I may be stuck doing things below my intelligence capability, but based on my with my functional capability. I haven't figured out how to deal with this or come to terms with it yet.

Shortly after the last diary entry I stopped taking medications for about six months.

I actually functioned quite well - using behaviour modification alone I was able to match or do better than medications I had been on.

But it was hard work, and in spite of all my control I destabilized over Christmas 1998, as I had done for every Christmas for at least five years.

And after that I restarted the medications.