Dull

Feels like I posted yesterday. Time passes, my presence transient. I went off medication for a while, depression of judgment settled snugly against mood and intellect. Little substance abuse, no help anymore. My escapist options have narrowed to unconsciousness. Rendered on couches and foam mats, always fully dressed. Waking to feel displaced. As though I slipped into another world, almost identical to my own. The subtle difference that I don’t belong, a me shaped peg in a stranger shaped hole.

I’m slowly accepting the truth my shrink offers. The promise of a normal fulfilling existence being but a few neuro-chemical experiments away. Desperately dodging the philosophical implications in the meantime; until I have a normal fulfilling existence, at which point I’m unlikely to mind terribly much. I just need a good pharmacologist, a little moral support and another few weeks of downtime.

I hope.

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Tags: Depression

Spinning World

I didn’t sleep for four days. It was awesome. My roommates starting thinking I was going insane, but I played it off. I had the advantage of knowing I was going insane. Only I called it transcendence. Comatose for two days partitioned by brief conscious blight I am at it again. The sun is rising over night number one. New medication soon. Until then waxing insanity.

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Back to Norml

Once again fogged wanderer, pot has rejoined me walking the path of life. or running the path, from the path, top speed, lungs burning. you can’t shake it. run further, still right beneath you. ran back. back to what to do. doing nothing.

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The Speed of Life

I’m in a pressurized metal cylinder burning fossil’s like there’s no planet to save six miles above. Twin rows of mind numbing drivel flash inches away from an army of travel optimized bags maliciously shifting in hopes of clipping the unwary. I’m in the back row. Late assignment left me unpleasantly unable to recline. It was that or a middle seat and knees be damned if I’m not an aisle man. Knees are damned all the same. A steady stream of well used air is keeping my face cool while I fail desperately at ignoring the persistent vocal masturbation wrought by over stimulated intercoms. I feel better.

If you triple punched and bindered the sum of my existence you’d use air travel for dividers. Separating the chaotic chapters with a brief blankness, unlined and unmarked and well defined. Brief moments of unreachable peace. Nothing to do and nothing to do about it. I rarely have traveling companions. Always alone in the shoeless herd. On my way to another attempt. A new hope that maybe, this time, I’ve escaped myself.

Functional Low

I’ve been down. The meds keep me functioning. I suppose that’s something. There’s magic in performing well when your insides are tattered. Black magic. Time to herald new drugs, more drugs. I’m halfway there. The glass half empty half. I’ve been wanting to write, but I have nothing to say. I sit and think longingly of dear friends. Those I’ve left behind. I ignore their calls. I have nothing to say.

Dr Sketch and his Magic Pad

Ever wondered how to find one of those pill doctors? Loose on scruples and willing to hook you up? Ask your insurance company. I just asked for a regular doc and in short the list of covered local psychiatrists the only one who could schedule within a month may just be that kind of pen happy physician. He scheduled me in two days. First clue.

Arriving at the shitty little eye soring wall hole a few minutes early for paperwork, I signed in. Just in fucking time; five more people hot on my tail checked in for the same slot and my appointment was still forty minutes late. I waited, trying not to touch anything. I went in, told him what I was taking, told him it wasn’t working. He checked his little book, checked his watch, chatted while he wrote, and chucked me out the door. Five minutes, five prescriptions. Efficiency. He’d given me the drug I requested, took me off the drug I hated, kept me on the drug I wanted, re-prescribed the drug I wasn’t taking, and started me on the stabilizing drug most noted for abuse potential. What a coincidence.

Prescriptions, at least the ones I’ve seen, come with a faint blue waves and tiny lettering elucidating the illegality of their absence. Come my second visit, he tried to drug me up on photocopied pads, failed because I’m not a retard, then proceeded to fuck up half my dosages. I was planning to go off Lamictal anyway.

Adding insult to injury, his office lacks a fax machine. What kind of (legitmate) doctor’s office can’t receive faxes? If you have an answer, please forward it to my insurance company. They needed a prescription authorized. They needed to fax it. I won’t discuss the headache it caused me. You probably already know.

I want to be clear, I’m not writing this to destroy his practice. By luck if nothing else, the regiment he prescribed, the portion I take anyway, has been the best I’ve experienced. If anything, I’m helping spread the word. I’m not a pill head, but I’m a pot head. I deplore the scheduling of substances. Spall your health, your mind, your life, it’s yours. And if my anecdotes were not enough to convince you, take a look at his business card:

Note: don’t take me seriously. I don’t want to get sued.

Four Hundred Twenty Treatment Options

Sweet Ganja. I’m a not a drinker, hard drugs are shit, but weed…weed is my savior, my one true vice. Our relationship is complex. I smoke when I’m depressed, less when things are good, more when things are great. More effect but cause all the same. When I cannot cope, it brings me sweet escape that brings the couch along. When I’m manic, a grass fired programming spree keeps me one step ahead of psychosis. A slip of paper gives my habit California’s blessing, deserved or not.

Does it help? It isn’t that simple. It causes me to stagnate, encourages my reclusion. Though it makes few problems, it solves fewer, but I feel better, if only for a little while. As mentioned earlier, my smoking cycles with my moods, and when I decided to give it a break 23 days ago I was stoned from commencement to curtain call. As devastating as that sounds, I still did what needed to be done. I’m high functioning high. Most who know me, who live with me, can’t even tell. My biggest complaint was memory impairment. Sober, I trust my recollections as godspeak. They rarely let me down. Throw in the encoding inhibiting properties of tetrahydrocannabinol and that asset is lost. Most frustratingly because it prevents me from learning, makes reading futile. On the other side it gives me insight, a novel perspective, new applications for the knowledge I posses; for many a half baked musing has risen in sobriety.

I quit for one month and the deadline is rapidly approaching. I have a choice to make. Do I hang tight to this mental clarity or allow myself envelopment in sickly sweet fog? And if I stay clear, stay focused, when depression strikes again can I face this indurate world knowing but a puff can ease the pain? I’ll start slow, one night a week, maybe two, but in time my smoking will again be determined by mood, not choice. Only naivety would expect less. I don’t know what I’ll do.

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Fishy Medicine

The vast majority of bipolar treatments have found a place on the goverment’s schedule of controlled substances. If it makes you happy, it can probably get you high. Or something like that. Omega 3 fatty acids come over the counter. About the size of a multivitamin, a pair could pose a solution to the darker half of the manic depressive conundrum.

I first heard of it from my councilor. The potential for mood stabilization without side effect was too much to ignore. So I bought a bottle. Since I really have no way to know if they are working, especially considering I was already being medicated with a host of pharmaceutical monstrosities, remained unconvinced of their clinical merit and decided to study up. The research is in it’s infancy with few double blind trials conducted on small test groups, but here is what I learned:

Omega 3s appear functionally similar to lithium (they both inhibit PKC )¹, the glowing difference being where lithium makes your mind dazed and hands shake², fish oil might give you a little stomach ache³. Oh, and lithium can fucking kill you. Oily stool or death? not hard.

A four month double blind study of 30 bipolarites showed promising results for anti-depressive properties. Unfortunately, 50% of the placebo group had dropped out by the two month mark because, well, they got depressed. Pumped with 9 grams/day, the omega-3 group held strong; even those on no other medications showed a marked decrease in depression³. The effect was so pronounced, in fact, that the study was prematurely terminated; they decided it was unethical to withhold the treatment from the placebo group⁵.

In another study, which I couldn’t read for free, they gave 10 people 2 to 3 grams/day. They used that classic questionnaire we’ve all taken to monitor their progress. Within a month, 4/5 had dropped 50% of their depressive symptom. Inconclusively, none of the test subjects experienced any manic symptoms during the period of the study⁴. Though several other studies suggest that the fatty acids have no effect on mania, positive or negative⁶.

One last point of interest. If you suffer persistent irritability, Omega 3 to the rescue. 37 manic depressives taking 2 to 3 grams/day cut their irritability in half. Rather than suffer 18 days of the grumpies every month on average, they got away with 9.

Overall, it’s clear fish oil has real potential. It’s cheap, risk-free, and if you suffer the mood swinging crazies there is no reason not to give it a go. Speculatively, it could well compliment the manic suppressing effects of traditional mood stabilizers with it’s penchant for battling depression. If you want to learn more, check out citations 5 and 6. Loose stools or not, Omega-3 has a permanent place in the medicine cabinet. Right next to my multivitamins…and sanity pills.
antidepressant

1. Inhibitory effects of omega-3 fatty acids on protein kinase C activity in vitro
2. Wikipedia – Lithium Pharmacology
3. Omega 3 Fatty Acids in Bipolar Disorder
4. Omega-3 eicosapentaenoic acid in bipolar depression: report of a small open-label study. -Abtract
5. Omega-3 fatty acids in mood disorders: an overview
6. Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid

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Never Leave Me Blue, Susie-Q

I knew she was trouble the moment I laid eyes on her. I’d dropped by Doc’s place, a shit hole rental in a shit hole complex with cracking plaster and smudgy windows. It was Saturday and the usual goons were lining up outside. Humid Day. My back was getting sticky. I was anxious to get out, so I tossed the cash on the desk and made to leave. The dust was still settling when he stepped close. He smelled of attics and whiskey.

-You got a girl?

-Sure

-Yeah? Well ya ain’t got one like this

He scrawled something on scrap paper, pushed it in my pocket. I left. I took the long way back, needed time to sort things. I crushed the ratty bit of greasy paper in my fist, pulled back for a fastball and the rain started. I jogged through the slick and took shelter at the local druggist’s. There she was, noctilucent ivory under rowed fluorescents. I had to have her.

And I did. Quetiapine, or Seroquel for short, has been my lady of the night for nearly a week now; when she doesn’t put me to sleep, she gets me high. My body fills with lead and my head with clouds for a mildly euphoric electrochemical storm. It isn’t unpleasant, but it comes on slow and catches me off guard. Oh, and then there’s the hallucinations. They have the same flavor as the hypnagogic hallucinations a younger, less responsible, me experienced on tired night drives. Specifically, I’ve been conjuring x-ray vision. It’s pretty fucking cool, if unsettling. The best was was when I saw through the entire house, to the street. An accurate representation too, save for the wrong perspective, in light of being in the basement at the time.

My memory continues to deteriorate. Short term thoughts escaping with increasing proficiency. Words too. I’ll be able to think all around them, but it can take half an hour to push them out from the tip of my tongue. I’ve had to start eating when I’m not hungry. I didn’t think the appetite change was a big deal, until I stepped on the scale and saw I was dropping weight like an anchor in friendly port. No thanks to Provigil, I’m sure. Ironically, I almost didn’t take it for fear of dramatic weight gain.

One more thing. I always do some research before I start a new drug, wikipedia at least, but I don’t read every word in one go. Today I noticed the very last section in the quetiapine article: Addiction and Abuse. Crap. Though I don’t intend to snort “quell” anytime soon, and experiences on erowid lead me to believe the recreational possibilities are minimal, I do not enjoy the prospect of being hooked on anti-psychotics, atypical or not.

Bottom line, Seroquel, I really like her, but I’m not sure things are going to work out.

The Really Scary Thing…

…is not knowing which me is nuts. I woke up this morning feeling totally sane and unable to shake the notion that yesterday I gone crazy. Not over the top lunacy, mind you, just your garden variety hypomania. Reading over my last post seems to confirm these suspicions, but here is where things get tricky. Considering my elevated mood hasn’t abated, and I am still feeling more or less like a total badass, it is probable that yesterday me would believe I am crazy now. I don’t feel crazy, but clearly that proves nothing. Now to complicate matters further, even if I could know which one was crazy I still wouldn’t know which was actually me. Even if both are crazy it’s no help. How transient is identity? Our we the sum of the past, of our words and actions? Or is true identity no more indelible than our current state of mind?