Monday, April 21, 2008

How Mood Stabilizers Feel and I want to Die

I thought I'd write a post to those of you who get to my blog by googling the above two topics. They seem to be common and maybe I can help you. Remember the following is based on my experiences only. I am a patient, not a Dr. and everyone experience these things differently. Please call your psychiatrist, or doctor if you are in distress. If you cannot get a hold of them and are feeling suicidal please call your crisis line and/or take yourself to the hospital. No one should have to cope with these things alone.

1) I Want to Die: (Please read this first)

I have felt this way this way too many times to count. You can find many posts on this blogsite where I have said this very thing. What has kept me here through 6.5 years of hellish severe treatment resistant major depression and twenty years of having major depressive episodes?

I'd say four things: My family, my psychiatrist, medication and some kind of resiliency inside me that clings to life even in my darkest moments.

Every time I think of suicide I am left with the thought about how, while it will be a release for me, it will forever impact those who love me. I have tried so many times to think of how I could die without impacting others, but after losing my Mom two years ago I know that is not possible.
Even if I did not have my family, I have a psychiatrist who does therapy with me once and for a long while twice, a week. He is intensely supportive, consistent, caring and available. I can speak to him about anything and every thing and trust he will help me. I tell him about my obsessive suicidal thoughts when I have them. Sometimes this is enough to relieve me of them if only for a while. I find sharing the thoughts and knowing he gets it to be helpful for me.

Some medications have helped me too...Epival, Valium (to reduce my anxiety, which sometimes leads to anxious, violent and agitated suicidal ideation).

Finally there is something inside me that never gives up, even in my darkest moments. Sometimes I just need to cling to the couch, or my pillow until I get through the thoughts and come out the other side alive.

My psychiatrist made a suggestion that has really helped. He told me to write a letter to my sad self on a day when I was feeling really good. So I bought a beautiful card and one day when I was feeling really well I wrote a point form note to my sad self about all the things that are good about me and my life. In the envelope I enclosed pictures of my family members and $50.

When I felt like suicide I open and read the note and look at the pictures. The $50 was an incentive to get myself out of the house and go buy something that made me feel good (a massage, or a new top, or a plant for the garden etc.) This really helps me.

I am not saying suicide is not your choice, because I believe ultimately we should all be free to make that choice. I am saying, it may be your choice right now, but you may not make that choice a few hours, days or weeks from now. If you commit suicide you will not be able to change your mind.

Please, if you are thinking of suicide, or planning to commit suicide, seek help. Call your doctor, call a friend, call the crisis line or go to emergency at the hospital.

2) How does a mood stabilizer feel?

I believe Aristotle was the first to say "Knowledge is power" (although Sir Francis Bacon also said it, but much later)...sometimes though, it is difficult to discern the difference between "knowledge" and "information".

They are two completely different things. There is tons of "information" about mood stabilizers out there. You could read forever about all the scary side effects...but remember:

You may NEVER experience those side effects!!

The drug companies are supposed to list all the major side effects that people have experienced (information), but until you try a particular medication you will have no idea whether you will have even a single side effect (knowledge). The information about possible side effects for the mood stabilizer I take, (Tegretol/Carbamazepine), would be enough to frighten even the most brave (or desperate) patient...I have had ZERO side effects from it.

Remember different people have different reactions to these medications. I have no idea why, but things I can't manage at even minute doses I have friends who are on HUGE doses who are feeling much, much better. Here is my experiences:

Lithium: I was so scared to try Lithium. I thought it would mean I was really insane (I am...ha, ha), or much sicker than I thought I was. I felt stigmatized by even the suggestion that I try it. I avoided trying it for 4 years. Then I tried it out of desperation.

At 1200mgs...Surprise, surprise...I felt almost instantaneously better and I had hardly any side effects, and no significant side effects. I had to pee more. That was the side effect. Unfortunately, it did not seem to work after I became sick with a really bad 4-week long cold/flu. I seem to remember my lithium levels going too high two weeks into being sick, causing extreme fatigue, which may have contributed to my being sick for so long. I lowered to 900mgs didn't help and then up to 1050mgs and I felt fatigued again and it didn't help my mood. I really wanted Lithium to work, because I felt comfortable with having so few side effects. Lowered to

Divalproex Sodium (brand names: Epival, Depakote): (tried 900-1200mgs) Epival quickly slowed down and lowered my intense feelings of rage and helped lower my anxiety. My mood still cycled, but the intense BAD energy dissipated and my thoughts of suicide slowed down. Unfortunately it came with side effects I could not manage. In the beginning my hair began falling out in clumps (I took 200micrograms Selenium a day with Zinc and this slowed down and eventually stopped). The big problem I had was trouble with my memory and attention. I would walk into a room and forget why I went there. I did memory tests with my pdoc and it was clear I was having difficulties. Still I remained on it until I got through and intensely bad period in my depression. It really helped the agitated energy inside me and was worth the side effects.

Lamotrigine 200mg: Tried twice. Once after 8 sessions ECT(2004). The ECT time my mood seemed to lift for a while. I seemed to become almost hypomanic like when I took it after ECT (could have been the ECT?). I had balance problems both times, but two weeks after ECT I was extremely high and running all over the place on the ice at a curling event. I fell a broke both elbows. Three weeks later I fell fell again off a curb into traffic, then fell a couple more times. Dr. X suspected it was causing balance problems, Tried 200mg again Jan/Feb 2007 with Lithium...nothing.

Gabapentin...might as well have taken sugar pills.

Carbamazepine (Tegretol): Since August/07 I have been taking this at doses of 600-900mgs/day in the p.m. I have ABSOLUTELY no side effects. I believe it slowly is helping my moods cycle less often, though I still cycle and I have been severely depressed on it until the past few weeks I really think it has slowed the lability of my moods...I cry less even when depressed, I can function a bit better even when depressed. I am taking it now with Prozac, Valium and Dexedrine, and I think it is helping me sleep better than before (Although I still go through long periods of insomnia like right now).

I haven't discussed my experience with antipsychotics as mood stabilizers. I know many people who take high doses of these and swear they help them. I could barely function on even low doses. I guess this supports the idea that we are all so unique in what does and does not help us and how we react to different medications.

I guess what I would like to get across in this post is that there is so much misinformation about mood stabilizers out there. If you read an article saying they will impact you negatively, you can easily find another that states the opposite. I have learned to both trust my psychiatrist to guide me through my medication trials, but never blindly. I still research what he suggests and we make the decision together about what I will try.

Being an active participant in my therapy, asking questions, working together with my doctor, and having a therapeutic relationship with my psychiatrist where I both trust my doctor's knowledge and his support is the way I make decisions about what medications I will take to try to help myself. I hope everyone has the opportunity for this type of an experience.


The Silent Voices in my Mind said...


On the suicide topic, I appreciate that you didn't lay on the melodrama and you didn't take away the personal choice. I like your suggestion about the card and pictures. Very helpful summary, I think.

On the topic of mood stabilizers, it is so hard to find balanced information out here. Everyone seems passionate to an extreme one way or the other or too afraid to say anything at all one way or the other. I like the way you pointed out the difference between information and knowledge and stressed that everyone is different.

I hope many people find you through this post and are comforted and reassured... I was.

Aqua said...

The Silent Voices Inside My Mind,
Thank you. I am glad you feel reassured. From your comments I do too. Sometimes it is as if I'm the only one that has these experiences.

The toughts inside my head are so brutal sometimes it's difficult to keep trying, but I do and I wanted to share some of how and why I do with others.

Polar Bear said...

wow, Aqua. GREAT POST!

I really really like the idea about writing a letter to my "sad self". I might steal this idea!


Aqua said...

"Steal" away polar Bear...maybe I will post my note so you can see what I did.

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