Toxic

I'm fine, but I'm bipolar. I'm on seven medications, and I take medication three times a day. This constantly puts me in touch with the illness I have. I'm never quite allowed to be free of that for a day. It's like being a diabetic.

- Carrie Fisher

Hats off to Carrie Fisher! I couldn’t have said it better. For me, medication is a daily chore. No different from brushing my teeth or making my bed. I’m on four different medications twice daily. I take up to ten pills a day.

I am bipolar in my attitude towards medication. On good days I will dutifully take my pills, thinking how much they have helped me. On bad days I will complain about them, how they make me feel flat, how they shackle my creativity, how they nauseate me.  Perhaps I’ll ‘forget’ to take a dose.  But it’s less of a choice and more a responsibility. A trade off between side effects and stability.  I have a little one to look after now.

After a night of violent vomiting a few weeks ago, I came to the conclusion that I must be suffering from lithium toxicity. It seemed the only logical explanation for my nausea, mood swings, and shakiness. My recent bout of illness and dehydration could have easily resulted in concentrated blood levels. It all made sense. Lithium toxicity can be serious, even fatal. My nurse was at my place to assess me within an hour of my phone call to the hospital.

I was told to stop the Lithium, and because I was worried (and because I was angry at the potential effect that medication had caused) I stopped all other medications as well. That was a mistake. I spent the weekend grumpy, depressed, and dissociating so badly that it was hard to walk.

When the blood results came back I wasn’t toxic at all. In fact, quite the reverse. My level’s were too low. So I restarted all the pills and quickly returned to my ‘normal’ (but really, what is normal? ;)) self.

How did my lithium levels become too low? Partly, I suppose, due to the IV fluids I was given during my recent hospital visit. But mostly, I suspect, due to my careless attitude towards the medication. Skipping a dose here, a dose there. I’m not crazy anymore. I don’t need that stuff.

I seem to hold a deep distrust in the opinion of the medical profession. Somehow I believe my limited knowledge on psychopathology and pharmacology is superior. Then I get upset when my  medication experiments backfire. Funny that ;) Recently I have been seriously questioning my diagnosis. Am I really bipolar? Was I really that unwell? Perhaps it was all a strange dream. Now, while I am stable, I simply cannot believe I became that unwell.

I talked to both my psychiatrist and psychologist this week about this issue. I remarked to them that I felt like I was making the whole experience up. I can’t imagine feeling that depressed, or that unstable. I felt angry that I couldn’t remember aspects of my experience. But the recollections I had and others provided just didn’t seem like *me*. Rather than telling me to move on, that the past is the past and the present is the present (what I have been telling myself!), they both explained that I had been through a kind of trauma. Not the hospitalization itself, as my experience there was a positive one. But the very fact that I became so unwell and so unstable. I had assumed my inability to remember key parts of my hospitalization was due to being...well...mad ;) I had also assumed my somewhat flattened affect and reduced emotionality now was medication induced. But both are apparently symptomatic of those who have experienced some kind of emotional trauma. 

Now don’t get me wrong, I don’t feel traumatised. Not in the least. But I suppose that is part of what is going on. I don’t really feel any emotional response to what I have been through. It’s just something that has happened, no different to going to the shops for groceries. Apparently this will change, and my experience will become integrated with my sense of self.

Writing, talking to people, and my weekly therapy all help me piece together this puzzle of myself. It’s fascinating. I have learned more about myself in the last three months than I think I ever knew. I say now, and I will say again, that the experiences I have had (however apparently traumatizing they may or may not be) are one of the best things that have ever happened to me. I feel a confidence in myself that I never had before, and I have learned what is important in life. I’m happy being me, something I wasn't for a very long time. 

I assumed I had lithium toxicity when really it was the lithium I needed to become well. I assumed that a diagnosis of bipolar disorder was negative, when it resulted in an area of personal growth I may never have attained otherwise. It’s funny how something so potent, something so seemingly toxic can actually be the remedy.

Lithium

I was against Lithium for a long time. I suppose I was tired of being pumped full of medications that never worked. Maybe I was scared of the side effects, and the risk of lithium toxicity. Perhaps refusing the medication was the last source of control that I had.  Whatever the reason, each time the doctors wrote it up for me, I would refuse to take it.

Lithium, to me, was a commitment that I wasn’t sure I wanted. Everything about Lithium seemed to revolve around ‘Do’s’ and ‘Don’ts. Do: have regular blood tests, drink enough water, monitor for symptoms of lithium toxicity, take the medication with food. Don’t: stop taking the medication suddenly, take the medication if you have gastro, take other medications without checking to see if they interact, get pregnant.  And even if I did do all of this there was no guarantee it would work anyway. As it was, every single mood altering medication I had been prescribed during the past decade had been a dismal failure. I had lost a great deal of faith in the psychiatric profession and in psychoactive medication.

But more than this, I think  Lithium represented my last chance, a lifeline that I was scared of giving up. Every time things got bad, a part of me would think “well...there’s always the lithium..”. But if I used it up, if I took it and it didn’t work, then what?

But one day, of course, things did get really bad. I fell to the ground in front of the other patients and howled from the core of my being. I was quickly escorted outside and medicated. “I can’t do it”. I whispered to my nurse as she held my hand. “I just can’t do it. I’ve tried. I can’t keep going anymore”. I howled again, clutching my stomach in physical pain.

The nurse gently steered me into the doctors office. Emotional pain became physical paralysis.  They helped me sit down. I stared blankly into the distance. They asked me: “What is the doctors name? What is the day of the week?  What is the prime ministers name?” The first question I knew. The second I had to think about – every day is the same in hospital. The final question I struggled with. Was the prime minister still that woman? Who cares.

That night my nurse came to give me my night medication. Two lithium tablets were sitting in the little plastic cup. “I don’t know if I can do it” I said. She sat down next to me “Look Rachael, I saw you this morning and it was absolutely horrible. It was awful to see someone in that amount of pain. It must be awful to feel like that, and yes – all medications have their risks, but surely anything....anything... is better than feeling that way”. I knew she was right. I knew I needed to take a leap of faith and trust the people who were trying to help me.

So I took the pills. I think I was expecting some kind of revelation to occur as soon as the white tablets touched my tongue. The heavens to open. The stars to collide.  But no. It was just like taking any other tablet, and life went on as normal.

The thing about Lithium is that you feel like crap when you first start taking it. Even worse, my first blood test revealed that my blood level was below the therapeutic dose, so much to my annoyance my dosage was increased. I was prescribed Maxalon for the nausea, but it didn’t help much. Another girl at the unit had just started her Lithium too. We bonded over shared side effects, and fantasized together about refusing our doses (Anarchy in the MBU!) I honestly didn’t ever believe it work. Nothing ever had.

But that’s the thing about bipolar. Standard SSRI anti-depressants don’t work, not alone anyway. Best case scenario you have wasted your money. Worst case scenario they make you a whole lot worse – or even trigger a manic episode. I had been a worst case scenario.

To my utter astonishment only a few days after taking the lithium at the therapeutic dose I started to feel better. A whole lot better actually. At first I thought it was a fluke. But my depression fell away, my mood lifted, my agitation lessened, my anxiety disappeared. I stopped crying. I started laughing.

And then I had to sheepishly inform my doctor that she had been right all along. To her credit she never said ‘I told you so!’ ;)

The major lesson I learned from this experience is to never give up. I had come to the conclusion that nothing would ever work to help me. That I was unsalvageable. I had given up on myself, and I had lost all sense of hope. Yet the thing that helped me was staring me in the face all along. I’m not going to proclaim that Lithium was a magic cure. It’s far complicated than that. But it did help stabilize me to the point where I could begin to use the psychological strategies that I had been taught. And for now I take those little white pills each morning and evening. But only for now :)