Tag Archives: lithium

Bipolar and mixed states.

Sometimes it is hard to know how you can control the next mood change.  At present it feels as if I am getting symptoms of both depression and hypomania.   My psychiatrist, over two weeks ago, increased my dose of sertraline to 200 mg, the maximum dosage.  So since then I have undertaken new projects as my mind started racing.  I intend to write a book that is semi-autobiographical and I have done over 3000 words so far.   It is about parts of my life but some bits will be fictitious,  as I pretend to have discovered the greatest melody ever written .  I have for a long time, since I was about twenty (I am now 37), pondered on the idea that mathematics could present a formula to enable me to find the best tune of all time.

During a recent hypomanic episode, this March/April, I purchased as many text books, the ‘…for Dummies’ ones, about maths and science as I could.  I feverishly worked my way through the first few books and exercise ones as well, thinking I was nearing a point where I could finally solve this musical riddle.  My doctor spotted the hypomania when I saw her in April and increased my dose of quetiapine to 600 mg daily.  This stopped the hypomania dead in its tracks and I was fairly level for a few weeks, until May 8th, the day after the General Election that I stayed up all night to watch.  When the result became clear and the Tories had a majority I cried my eyes out which is something I hadn’t done for a while (I feel that the medication blunts emotions like crying, and hysteria but that is something I just have to live with yet I used to love crying to beautiful music as a way of releasing pent up emotions) and almost immediately my mood plummeted.

Between May 8th to 29th June I was in the grasp of a serious depression and I thought longingly about ending my life, which was constantly going through my head.  There is nothing more disturbing than a human brain planning, or instructing its occupying mind to terminate itself.  Why would it do that?  I feel sad every time I read about people  committing suicide as it defies logic.  Are aim on this planet and during this life is to fight and endeavour to survive, have a safe place to live, be kind to others, and the most obvious, reproducing.  I reached a stage where I had made plans to commit suicide and written notes for my wife and children.  Yet, thankfully I saw the psychiatrist and my care co-ordinator at just the right time.  Seeing as there was room to maneuver with my medications I could take onboard the increase in sertaline.  This has rid me of the suicidal thoughts but like I wrote earlier I think it has tipped me into a mixed state.

In a mixed state you can have racing thoughts and wonderful ideas yet you feel utterly miserable and irritable.  I don’t think I have had a mixed state before, probably have but just didn’t recognise it.  I remember, many years ago, I saw a young doctor who was under the wings of the main psychiatrist, he prescribed me sertraline.  Well I remember my mood rocketing into happy hypomania.  I would stay up late writing and illustrating a comic book about a character I had created (loosely based on an old friend of mine, who actually read it and quite enjoyed it) called The Brizz.   This went on night after night and was long before I was taking lithium.  Also, this period also led to borrowing lots of money and getting into serious debt.   The same thing happened when I was started on citalopram, I was taking 10 mg a day and my mood shot up, which I recognised this time but I had little joy when I tried to explain it to a Community Psychiatric Nurse.

Since taking lithium I have found that it controls the impulses that hypomania brings, but I still get breakthrough symptoms which is what I think I am experiencing at present.  A part of hypomania is aiding me to write this blog post as I couldn’t muster any will to produce if I am in a period of low mood.  This current mixed phase has also led me to play the piano for several hours each day.  I play until sweat is dripping down my face and back.  I imagine I am performing in a concert yet get utterly frustrated when I can’t play a certain passage as well as I could.  At the moment I am devouring JS Bach and his son CPE Bach.  Their compositions are divine and I find myself constantly repeating the most beautiful passages over and over again.  There is a Toccata by JS Bach, that is in E minor BWV 914, the first three movements are full of intertwining wonder but it is the fugue that completes the piece that I listen in awe to.  I can nearly play it, but not quite as well as the humming Glenn Gould.  Sometimes I don’t have the patience to practice tricky passages and get annoyed.  I just want to play perfectly each time, and chastise myself when I get it wrong.

My music tastes vary like my moods do.  I am solidly transfixed by JS Bach and his son at the moment but over time I will venture towards slightly more modern pieces.  This is when Muzio Clementi re-enters my playing life.  I have nearly all of his piano sonatas and while they are fairly difficult I find them a pleasure to play.  Then of course Clementi’s contemporaries Beethoven and Schubert get invested into my playing schedule.  But I love playing and researching (Spotify is the greatest invention of the modern world for finding pieces by lesser known composers) music by ‘minor’ composers such as Dussek and Hummel.  They are worthy of higher esteem but were always in the shadow of Beethoven.

Along with my idea about a most tuneful tune I also wonder if it is impossible to witness our own death.  This all goes back to an American scientist named Hugh Everett III.  He had an interpretation of quantum mechanics that was named the ‘Many Worlds Interpretation’.  As this idea evolved and other scientists latched onto the idea, especially the Swedish physicist Max Tegmark, they said that for every decision you make like going right instead of left and vice versa another ‘you’ in another Universe goes the other way.  So what about the idea of not witnessing your own death?  Well, I am not a qualified scientist but I thought back to all the times I should have died but didn’t.  In a different Universe I did of course, but for some obvious reason we always chose life over death.  I remember driving a Taxi to Woking one Sunday morning.  I had had a good night’s sleep and was looking forward to a simple run around the M25 for which I would earn about fifty quid (after fuel of course).  I was taking an elderly couple home from their holiday on a cruise ship and when we reached the destination the gentlemen thanked me for the journey but handed me five pounds so I could get a coffee on the way home.  Apparently I had been dozing off at the wheel.   So in another Universe that would have ended in tragedy, yet somehow in this one we survived.   This happened quite a lot as during the summer months as the M20 was my second home and I used to get hallucinations from the constant motorway driving, along with persistent micro sleeps.  My dad, also a taxi driver, had once seen a boat go across a motorway bridge because he had been doing so much motorway travelling.  Now I don’t drive and have surrendered my driving license back to the DVLA.  This was because I started to have panic attacks at the wheel which terrified me.  I think about all the miles I used to drive as a taxi driver and now I am crippled when it comes to motoring.  I am not sure what caused this but it may have all the criticism I used to get at work for my driving.

I am probably completely wrong about all of the above, but it is a conjecture that sticks in my unqualified mind.  It’s like the vast amounts of cider and vodka I used to consume from 2005 to 2011, yet my liver is perfectly healthy and there was the time I tried to strangle myself in my dad’s garage, I was 19, yet failed to die as I wanted to.  That is a grim memory from a passage of my life that I would rather forget.  Yet as I was suffocating I saw images of people I knew.  If we do witness out own death then I would imagine it to be like being under a general anaesthetic when you don’t dream, and know nothing.  I suppose I am more worried about how I might die rather than death itself.  Yet is would be nice if Many Worlds interpretation is correct, although you would have to have a demise eventually.

So I thank the sertraline for giving me a small portion of hypomania to be able to compose this rather morbid blog, yet I am a fairly open to writing about these things.  It shouldn’t be a taboo anymore, along with mental illness not being a stigma or a block to stop people progressing in their careers or passions.   When manic I want to take on the world with my ideas and thoughts.  Which is why mental health should be taken as equally important as physical ailments.  I don’t know if this country will ever achieve that as mental health wards are being shut across the county of Kent at least.  I have come across a lot of prejudice when people have found out I am mentally ill.  One ex-colleague in my last job was scared that I would attack him with a chainsaw, which of course I would never do.  But that is the mood set of some people if they have never experienced first hand mental health issues.  I just hope for the day when it won’t be shameful to be open about mental illness.

New course

The first arrival came today for my writing/history courses.  It’s about to begin, knuckle down and do some interesting shit.  Hopefully my ambition of getting a degree will come forth in twelve months, as this creative writing course doesn’t look too daunting, on the surface.  So about time I got stuck in before getting overwhelmed.  That can happen, or at least to me.  You feel the need, urge, to complete the course before the edges of the textbook get scuffed.  There is plenty of time, and is designed to be done in months not seconds.

I have calmed down a bit from the stewardgate episode from the weekend.  Still annoyed that people still accept this level of stewarding at this level of football.     That’s me getting upset too easily, for no reason.  Just like I don’t want to go near the in-laws, I will just make a fool of myself.  Similar to having Jehovah Witnesses knocking at the door, I enjoy the argument but get wound up by their profound stupidity.  The in-laws are stupid too, must make sure that is said quite clearly.

This is written as it comes of my mind which is why I need a lithium check or I’ll become a dribbling prick with no substance, just like where this sentence is heading.  I don’t feel too wound up but I did wake up too early and feeling quite blue.  Watching some George Carlin and Doug Stanhope (highly recommend both) cheered me up and so far I haven’t had a cider, but a mere couple of solpadols.

Out.

Bipolar or not

I have a lithium level that is below therapeutic levels.  So in effect it is doing nothing.  The dose is not high enough.  My GP wouldn’t raise it the other week because I was depressed so she said we will see how it goes.  Fair enough I though, but my mood has changed.  I have become very irritable, with a racing mind and spending money I don’t have.  I have grand ideas too.  But I am not bipolar.  I bet I am.  Shouldn’t self diagnose.  Maybe the olanzapine is holding some of the symptoms in because that can act as a mood stabiliser.  I don’t feel high as in ‘happy high’, but I feel overwhelmed and hyperactive.  Concentrating on one thing is hard for too long.  I have been going for walks to try to burn of energy but it doesn’t really help.  It is a good thing I have mirtazapine, that works just right every night.

Drug regimen

8 am Venlafaxine 375 mg

Lithium 400 mg

10 am Pregabalin 300 mg

2 pm Pregabalin 300 mg

3 pm  Olanzapine 15 mg

10 pm Mirtazapine 45 mg

Lithium 400 mg

Plus, add in codeine PRN.

I don’t care if people think this is a shit blog.  It is something for me to look back on.