Quote du jour (from Life Journal)

Every individual has a place to fill in the world and is important in some respect, whether he chooses to be so or not.

--Nathaniel Hawthorne

Best Laid Plans

So much for avoiding any medication changes when I start my new job.

The antidepressant (Wellbutrin) is making me manic. I'm on the borderline between hyperfunctional (hypomanic) and dysfunctional (manic). Conveniently, I had a med appointment today.

We're changing all my medication. At this point, we're adding a second mood stabilizer to the lithium, and eventually we'll taper off the lithium. After a long discussion of the merits of two different mood stabilizers, Depakote and Tegretol, I picked Depakote.

I asked him what I should do given that I have a medical reason to lose weight (my arthritis), and he basically said that I can't help you. (Most of the mood stabilizers slow down metabolism and increase appetite.) I said, "Don't tell me that." We considered Tegretol because it's slightly less likely to cause weight gain. I also brought up a new drug called Topamax that has a side effect of weight loss, but he was uncomfortable prescribing it as the sole mood stabilizer. (I wonder if we could mix Depakote and Topamax; I didn't think to discuss that possibility.)

The reason that I picked Depakote is that more people seem to tolerate it better than any other mood stabilizer, although I'm aware that everyone's chemistry is different. If I didn't try it, I would wonder how well it would work for me. Also, Tegretol is more likely to cause daytime sleepiness and confusion than Depakote.

Hair thinning is a common side effect of Depakote, so I picked up some zinc and selenium in an attempt to avoid the side effect.

He wanted me to completely stop the antidepressant, but I convinced him to let me try a lower dose because I don't want to bounce back into depression and because it has a side effect of weight loss. I probably would want to stop sometime in March anyway because I normally get manic in the late spring.

So....I'm feeling really mixed emotions about this. It really sucks when you're feeling good, productive, and at the top of your game to have to say "I'm getting sick. Stop this." I'm really processing this as a loss. Also, I'm going to have to deal with potential side effects (or the possibility that the drug won't work for me) while starting my new job. On the other hand, I've been petrified of getting manic (because mania can screw up your life a lot more than depression), but the system worked. We caught it at the exact right time to catch it, and it probably won't go any farther. I'm also really enjoying working with my doctor.

Sorry, I won't get to my friends list tonight. I should be asleep already, and I need to start taking my bedtime more seriously.

What bipolar meds do

On a Q & A entry on a bipolar site, I found an excellent description of how mood stabilizers affect someone with bipolar disorder:

I have just begun to take 750 mg of Depakote per day (have only been taking the full 750 mg. for a week now), and nothing earth-shattering has happened except 1) I am calmer and much less irritable; 2) I still have emotions but they are subtler, not like being hit in the head with a two by four (I suppose these are more like normal emotions) - I even find myself happy in a relaxed rather than an excited way; 3) This summer, I do not feel better, smarter, etc. than everyone else including my husband, feel that I have married way below me and feel very tempted to have affairs with the men I believe I "deserve". If this keeps up, I imagine I won't feel by late fall or winter that I'm genetically defective, don't deserve the men I was fantasizing about and that killing myself is the rational solution.

The last couple of lines cracked me up. Yes, I know, gallows humor....