Cha-Cha-Cha-Changes: Getting better at them all the time

(‘Changes’ song lyric sample from David Bowie, album “Hunky Dory” 1971)

When the seasons change, I often have a bipolar relapse, one that starts small, like a snowball, gathering speed and size as it rolls down the hill, exploding on the impact of hitting bottom! Boom! On September 24 this fall I had to admit, as anhedonia and thoughts of throwing myself off of my balcony were the norm, I had to admit that it had happened again.  Since this has happened to me six times since my diagnosis in ’89, I’ve gotten so much better at picking up the pieces. I’d like to share my learning curve with you, since you might be in my shoes one day, and confused about it all. (There is a phrase chuckled about in clinical circles, called Prozac-Poopout, referring to when an antidepressant can become ineffective over time.) So I know I’m not the only one this has happened to.

The first time this happened to me, I was at the top of my alternative radio career, playing music from artists who sang of depression and self-loathing. (Nirvana, The doom and gloom of The Cure, The Smiths and Depeche Mode.) It was even fashionable in the 90’s, along with Heroin Chic, to have mental illness and express it. I’d go as far as to say that my illness fueled my talent and played a part in my success as a music director and on-air personality. I understood those artists the way most people did not. 

I’d taken my prescribed mood stabilizer and an early SSRI without incident for ten years. I’d neglected, as I moved from market to market (as we tend to do in the radio world), to see a psychiatrist and got my medicine from my internists.

In Phoenix in 1999, I was a newlywed, my SSRI had stopped working and my perception was that my antidepressant was the be all and end all.  If it stopped working, as it did, my case was hopeless. In ignorance and fear I panicked; self-medicating, which made my case progress to bipolar I.  

I ended up in a long-term eating disorder/psychiatric center for women in Arizona, and went to a half-way house afterwards. I was put on an antidepressant that actually was released before SSRI’s even came on the market and it had a few thing I liked about it: For one, it worked, it didn’t have side effects of weight gain and had no sexual side effects. I tried to salvage the marriage, but my husband said that he didn’t want a wife with bipolar disorder, due to the risks of me becoming very ill, or permanently disabled. We divorced. I fell apart. 

On vacation in Florida I was committed against my will and met the psychiatrist I now have. It’s been 15 years. I’ve had 5 bipolar depression relapses with him, and we do what historically has helped the most.  We start a new antidepressant and wait for it to work.  I get a lot of mileage out of hope. I have confidence in him, and like his collaborative approach, one that’s not appropriate for every patient but is for me.  I actually feel better when I see him, even when I’m at a low point. 

The last three relapses have been surprisingly short, once I stopped denying them. The last three medication changes have worked within a week, surprise, surprise.

I think that overall, the medicines are getting better. And we have more of them to try.  These days, if I have mood problems, I waste no time and go see the expert. He’s usually right on target with me. He’s in his 70’s and will retire soon. I’ve gone out and done ‘intake’ with younger psychiatrists to see who is out there. One of them, a dictator with a Vertical (Top Down) style of treatment threw me out of his office in three minutes. Because I have a movement disorder and a history of substance abuse (1999), I get turned away often. This is worrisome. I’m going to do another round of ‘shopping,’ and will blog about that in the future. Maybe you’ll be able to help me.  I hope. 


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