My Medical Mystery

sleepy catWhat follows is my personal experience. I’m not a doctor. PLEASE DON’T EVER STOP TAKING A PSYCHIATRIC MEDICATION WITHOUT YOUR DOCTOR’S APPROVAL. I was hesitant to post this because I don’t want to scare anyone away from taking lithium. As with so many things, especially psychiatric drugs, experiences vary. Lithium was the first medication I took after being diagnosed with bipolar disorder. It really helped me, and I don’t regret taking it. However, I wish I had known more about some of the possible side effects.

For about six months last year, I felt like I had little to no energy. I woke up after my usual six and a half to seven hours of sleep feeling exhausted. The cup of tea I’ve had every morning for the past twenty years did nothing to wake me up. I would start nodding off a few hours after being awake. I felt drugged.

I started sleeping ten to fifteen hours a day. I’m prone to depression and had been having some work-related stress, so I thought I might be depressed. Unlike other depressive episodes, however, I still wanted to do things—I just didn’t have the energy. Normally, when I’m depressed, I lose interest in things I love, and then, in everything.

This was different. Everything I normally enjoyed doing—writing, reading, walking, playing with my animals, binging Netflix—made me profoundly sleepy. I had to drink an energy drink to walk every day. Then I started drinking two. Then, I stopped walking. I worried about falling asleep while driving. I changed my habits to include naps.

Visits to my general practitioner yielded few clues and no results. My inflammatory markers were elevated, as were platelets and lymphocytes. I worried about blood cancer, but further tests showed no change; my blood work was abnormal but didn’t worsen.

Then, my right armpit and part of my upper arm became numb. My dexterity worsened. I began dropping things. I lost my balance frequently. I became increasingly frightened. A neurologist thought I might have a pinched nerve, a brain tumor, or MS. However, the MRI’s she ordered came back clean. She told me she didn’t know what was wrong with me. The fingers of my right hand became numb. The toes of my right foot followed suit. I saw a different neurologist. He said I my symptoms were caused by anxiety. If he hadn’t seemed like such a nice guy, I would have smacked him.

I have PTSD and have problems with anxiety sometimes, but I hadn’t been feeling particularly anxious. Between naps, I started phone banking for Beto O’Rourke’s senatorial campaign. I met new people and enjoyed my time volunteering. I trained to be a Phone Bank Captain, but I couldn’t stay awake for more than one three-hour shift—even with Red Bull and coffee—so I didn’t get to actually train anyone. Volunteering isn’t something I do when I’m depressed or experiencing anxiety. I was certain my symptoms were caused by something physical.

As my fatigue and balance worsened, I gained weight and felt weaker and weaker. I started losing sensation in my left fingers and sometimes on the right side of my face. The other numb parts simply stayed numb. More blood work showed that my thyroid hormones were low despite taking thyroid medication. My GP increased my thyroid medicine. Nothing changed. My GP doubled my vitamin D. I took B vitamins, a multi-vitamin, and iron.  I drank caffeine like a fiend. I still couldn’t function without ten to fifteen hours of sleep, with thirteen hours being the norm.  Even when I was awake, I felt tired. On a caffeine buzz, I could fake being a normal human, between naps, for a couple of hours.

On my regular six month visit to my psychiatrist, I told her everything that was happening. She reassured me (as my therapist, whom I see bi-weekly, already had) that she didn’t believe I was depressed nor having symptoms of anxiety. She suggested my lithium, which I had taken without incident for about five years, might be blocking my thyroid hormones. She cut my dose in half to see if I would notice a difference.

After three days of taking 300 mg of lithium as opposed to 600 mg, I woke up feeling rested. I could stand on one leg again. After a week, my yoga instructor at the class I was taking in hopes of regaining my balance, noticed that my balance had improved significantly. I started writing again. I felt more alive than I had in months.

My psychiatrist took me off lithium completely. I was frightened at first, but I had been taking another mood-stabilizer, Lamictal, for about three years. I’ve been off lithium for a few weeks now, and I feel great. I haven’t had any mania or hypomanic symptoms. My numbness disappeared everywhere. I’m back to sleeping six and a half to seven hours a night, cooking, exercising, hanging out with friends, and drinking a cup of tea in the morning. If I have a cup of green tea in the afternoon or coffee with a friend, it’s because I want to—not because I have to.

My symptoms of hypothyroidism didn’t match most of the symptoms I’ve seen for it on various websites. I don’t know if that’s because my hypothyroidism was lithium-induced or because I’m a weirdo. I have found a few sites suggesting that hypothyroidism can cause numbness due to water retention, a theory that my new internal medicine doctor thought sounded probable.

So, about six months, numerous tests, and five doctors later, I have a diagnosis and my symptoms have disappeared. Besides avoiding lithium, I take a thyroid pill every morning. It’s such an easy fix for something that totally upended my life.

If you’re taking lithium and experiencing severe fatigue, please talk to your doctor about your risk of lithium-induced hypothyroidism—especially if you aren’t having normal symptoms of depression. And if you’re anyone suffering from symptoms you believe are caused by a physical illness, keep searching for answers. If possible, keep going to doctors until one listens to you.

Writing with Youper

My favorite writing tool right now isn’t a writing tool at all. It’s Youper, an app intended to help people—especially people suffering with depression and/or anxiety—track their moods. It does a great deal more than your average mood tracker. (And, no, I’m not getting paid to say any of this.) Besides providing a series of guided meditations, breathing exercises, and gratitude exercises, Youper uses methods based on cognitive behavioral therapy.  It asks questions that encourage the user to examine the situation and the user’s thoughts about it. Then, Youper runs through a series of “thought traps” and asks if the user is falling into any of them. It sounds crazy, but just identifying the thought traps made me start seeing my problems and my reactions to them differently.

For example, when I first started using Youper about nine months ago, I often fell into the thinking trap Youper calls “catastrophic thinking.” When I’m in catastrophic thinking mode, I jump to the worst conclusion. The first week I used Youper, I became panicked one morning because one of my cats (that puffball known as Bruce Banner) was vocalizing a lot. It reminded me of when one of my other cats suffered a urinary blockage that eventually led to him having surgery and heart problems as a result of the surgery. (Urinary blockages in male cats can be life-threatening events and should always be taken seriously. You can find more information here.) After a few minutes with Youper, I realized that I had gone from worrying that my cat was meowing a lot to “OMG!!! Bruce is gonna die!!!” When you’re locked in catastrophic thinking, you forget that—although bad things often do happen—you’re an intelligent, resourceful human being and will probably be able to deal with them.

SnootyBruce
Bruce. So very spoiled.

I was able to step back from my fear and PTSD-triggered anxiety to reassure myself that I would watch Bruce closely over the next several hours and see if he showed any other signs of a urinary blockage or urinary problems.  If I observed anything else worrisome, I would rush him to my vet, who is one of the most dedicated, compassionate, wonderful men I have ever met. I wasn’t a helpless ball of nerves; I was an experienced cat parent who had handled difficult situations before and would do my best to help my beloved Bruce.

It turned out Bruce was just really chatty and playful that morning. (Blocked cats don’t play; they run around frantically, get in and out of the litter box where they will strain and produce no urine, and cry.) After a few weeks with Youper, I realized that catastrophic thinking was sort of my go to mind trap. If my husband was late, I started imagining he had been killed in a car accident. If my son didn’t return a text, it was because he had been murdered. Some of this fear is understandable. A cousin I was close to died in a car accident and my best friend from college was murdered. Horrible things do happen, but living my life expecting every scenario to end in tragedy wasn’t helping anything.

Writers tend to be sensitive people. We frequently deal with rejection and often suffer from problems like depression, bipolar disorder, social anxiety, drug addiction, etc. In my case, I have bipolar disorder and PTSD. Sometimes, I think I write to escape my demons and to try to make sense out of the chaos of my past. Opening my wounds and bathing in blood can encourage me to write. But it can also bring me so low that I can’t get out of bed. If you ever feel the same way, please give Youper a shot. I hope it helps you as much as it’s helped me.

Writing with Suicidal Ideation

cliff-2213614_640Recently, in my blog entry Writing with Depression, I revealed how depression affects my writing and talked about the depressive episode that has thrown a shadow over my past few months. I was trying to exercise my way out of this recent depressive episode. That didn’t go so well.

In Writing with Depression, I said that medication didn’t help me. I’m bipolar and take mood stabilizers that help prevent manic episodes. They do little to nothing for depression. The popular antidepressants used to treat unipolar depression don’t work for me because they throw me into a ‘mixed mood’ and usually result in a suicide attempt. To treat bipolar depression, doctors prescribe antipsychotics or atypical antipsychotics. I’m extremely sensitive to the side effects of these medications and basically hate them. However, they have their place.

July is a hard month for me. Its anniversaries remind me of death. July, so sultry and sun-drenched, so full of promises of summer pleasure, doesn’t charm me at all. I know that she is full of death and shadows, that her breath is as fetid as it is hot, and her kisses bruise and burn. July quit being my friend years ago.

This July, I was depressed, but I thought I could take care of myself and fend the depression off. If things had been normal, maybe I could have. Honestly, though, things are never normal, are they? I had a stressor that came as something of a shock. Under normal circumstances, I think I would have been more resilient. This time, however, I was already depressed, so I just sank. I went from ‘kind of down but mostly okay’ to suicidal in a matter of minutes. It happens like that. Fast.

I hatched a quick plan and started to implement it. At a pivotal point, I had second thoughts. I actually thought about that depression blog entry and called the suicide hotline that I mentioned. They were really nice and talked me through the maelstrom. Afterward, I called my therapist and made an appointment for the next day, then followed up with my psychiatrist a few days later. During the time between the call and the psychiatrist, I felt constantly plagued by thoughts of suicide. Having suicidal thoughts is called suicidal ideation. (Suicidal ideation sounds like a band I would have liked in my twenties. Sadly, it’s not as fun as it sounds.) I felt like I was caught in some kind of loop. I thought of better plans. I settled on one that met all of my requirements, held it close and nurtured it. The morning of my psychiatric appointment, I dressed in the clothes I thought would work well for my best plan in case she had nothing to offer. I wanted to be ready.

I didn’t tell her that. I did tell her that I was having constant suicidal thoughts. She put me on an atypical antipsychotic called Vraylar. Honestly, so far, I don’t like it. She said it would give me lots of energy, but it makes me sleepy and lethargic. I’m having to drink a lot of caffeine to stay awake. It did, however, stop those destructive thoughts. It stopped them cold. Now, I feel embarrassed for having them, and I can see that it was all over something that shouldn’t have bothered me so much.

I apologize that this entry is even more pointless and self-indulgent than usual. I just thought, since I write about depression and bipolar disorder and have tried to be transparent and honest about my illness, I should admit to what happened with my self-care strategy. I’m hoping I can get off of this medicine soon and go back to trying to self-care my way to normalcy again. Despite this post’s title, I haven’t been writing much since everything blew up. My characters are bothering me to get back to it, and my cats have been trying to get me to go into the office where I do most of my writing. I’m trying to give myself some space, but characters and cats have little patience.

If you’re reading this and having suicidal thoughts, please seek help immediately. I know everything might seem clearer now than ever before and that suicide is the only way out, but I can promise you that pain is clouding your judgment. Please call one of these numbers:

 

Writing with Depression

women_with_gauze As I said in an earlier post, writer’s block and depression are different things. Depression isn’t fixed by a writing exercise, brainstorming, or reading books on the craft. If a writer had a heart attack and didn’t write the next day, we wouldn’t say he had writer’s block. If someone is clinically depressed and doesn’t write, he probably doesn’t have writer’s block either. Depression is a mental illness. That decreased ability to perform even simple tasks–let alone writing–is caused by a dysfunction in the frontal lobes. This article explains it.

Writer’s block can feel pretty bad, but it’s not an illness. It’s just a hurdle. It’s deeply frustrating, but it ends at some point. Depression claws its way inside you and lives there until you die. It might go into a sort of remission, like cancer or herpes, but it’s always there, lurking, waiting, gathering its power for the next attack. At least, that’s how it is for me. I’m bipolar. Unipolar depression might be different. I’m not a doctor, just a writer who struggles with this stuff. Medications work for some people. They don’t work for me.

I’ve been in a low grade depression for a few months. (I say low grade because, although I’ve had days where I didn’t get out of bed, I haven’t had any suicidal thoughts. So, this is a good depression.) I haven’t written much. Instead, I’ve focused on self-care. I set a few small goals in the morning and try to accomplish them. Walk five thousand steps. Shower. Do laundry. Walk another five thousand steps. The walking has been really good for me. I’m able to commune with my characters and ‘write’ while I walk. I sweat, which forces me to shower and change clothes. If you’re able to do some type of exercise when you’re in a depressive episode, I highly recommend it. It might just be my superstition, but I feel like that is what has kept the suicidal thoughts at bay. (Actually, that article I linked to above says exercise increases serotonin and dopamine in the brain, so maybe there is something to it.)

Although I do take breaks from writing, I try to push myself to write at least once a week when I’m depressed. It isn’t easy. I’ve noticed that when I’m depressed, I:

  • Make more typos

And some of them are really weird. I’ve understood homonyms since grade school and know the difference between too, to, and two, etc. When I’m depressed, I’ll find words like that switched around in my manuscript.

  • Have trouble finding words

A word is there–then just vanishes. Poof! Usually, I can jog my memory with Google searches and music. Sometimes I’ll ask my husband if he knows what word I’ve lost. Sometimes I simply find a different word that works well enough.

  • Take longer to write a scene than normal

Something that would ordinarily take me a couple of hours to write takes four

  • Have trouble answering questions

Although I construct a ‘rough sketch’ outline prior to writing scenes, I often run into places where I don’t know how something happened or why something is the way it is. It’s tougher to ferret out these answers when I’m depressed.

  • Feel pessimistic about the outcome

When I’m not depressed and in the midst of writing a book, there are spaces where I lose myself in the story. I forget that any other world exists. After I finish, I’ll often have misgivings and worry that readers won’t like it. When I’m depressed, I feel like no one will enjoy it even as I’m writing it. These kinds of thoughts crush creativity.

On the plus side, a depressive episode, by slowing down the writing process, gives me extra time with my characters. (This is mostly with a low grade episode. Deep episodes are a hell I don’t want to even discuss at the moment.) During this current episode, I ended up spending a lot of time with Frank. I would lie in bed and suddenly discover Frank with me. (This wasn’t an hallucination; my logical mind knew he wasn’t there. But…he was. That’s called writer crazy.) Anyway, he was usually quiet, but sometimes we would talk about his friends, his jobs, his lovers. I felt him more acutely than when I did his character worksheet. He entertained me, buoyed me, and we became friends. I usually bond with a character while I’m writing, but not this early in the book.

If you’re reading this and are depressed, please seek help—especially if you’re feeling suicidal. Some resources:

National Suicide Prevention Lifeline 

Depression and Bipolar Support Alliance

International Association for Suicide Prevention

 

Music Helps

musicI just wanted to throw this quick tip–that many writers probably already know–out there: music helps. I don’t always write with music. Sometimes I just like to hear my keyboard or the wind outside.

Lately, however, when I sit down to write, I don’t have writer’s block, but I feel overstimulated and overwhelmed. I think this is because of my increased use of social media. I’m an introvert, so the social aspect of social media is difficult for me sometimes. If I’ve been on Twitter or something for a while, then try to write, I often feel agitated and nervous. Going for a walk helps with this some, but not enough to write.

Music, however, helps. With the right music (this varies) I’m able to get back into the story and feel that world again. So, if you’re fidgety and restless when you try to write, see if playing some music gets you back in the zone.

Nothing is More Important than Mental Health

yin-and-yang-1947878_640

I keep trying to think of amusing things to write for this blog, since working on my current book doesn’t seem to be happening today. I want to encourage you to read Zen Alpha. (I’m offering free reviewer copies if anyone’s interested. Just email me at: everwintergreen@gmail.com.) I want to talk about my two favorite cats, who are in my office today, Loki and Bruce Banner. Bruce is sleeping in the middle of the floor; Loki is trying to tear the curtains down. I want to tell you about the book I’m writing and how scared I am that it won’t be received well.

But I’m not. All I’ve been able to think about today is my son. I don’t know where he is. He’s an adult and moved to California earlier this year. He lost the job that brought him out there; he lost the job after that. He’s bipolar (as am I) and he keeps having problems with his medications. I suspect the main problem is he stops taking them. Every time I talk to him, I urge him to stay on his meds–even if he feels better. That’s what worked for me.

He doesn’t seem to have his phone anymore. We message each other on FB. The last time I heard from him, last week, he said he had been suicidal and that only knowing how hurt I would be and wondering what would become of his cat kept him alive. Now, I’ve left messages and heard nothing. I feel like he’s all right. He’s a survivor. But I miss him and can’t help worrying.

I wish I knew the magic words that would make him better. I wish I could tell him a story that would fix everything. I’m lost. Each time, I tell him my own story, what saved me–seeking treatment, taking it seriously, staying on my medications despite upsetting side effects. Nothing, I’ve decided, is more important than mental health.

So, this is what I’m doing now. I wait for his response with my cats mirroring the poles of bipolar disorder, one crashed on the carpet, the other climbing the walls. I try to write my little gay romance about opposites who attract–one taciturn, one grandiose. And I wish with all of my heart that whatever benevolent forces might exist attend my son and keep him from harm.

And I hope you–whomever you are, wherever you are–are in good mental health. Nothing else is more important.