Holding on, waiting for the thunder

So far, med free. The shrink called and is back from vacation, but I’m debating whether to go back or not. I really only need to if I decide to try meds again. So far, I don’t feel so great, and STILL having some withdrawal issues, but it is a little bit nice to remember who I am underneath all the medication.

I guess I should return the call to at least inform him. Why is this like breaking up? Why is the worst, most dysfunctional relationship in my life the one I have with my shrink?

I didn’t get my nice hypomanic buzz at coming off any of these. And my hypersensitivity is setting back in – every little touch feels like pain, clothes are uncomfortable, etc. But this is who I am, raw and pure. I will take it for as long as I can.

Since this is another piece of self-indulgent bullshit, if you have been following Purple Dog at all, be sure to update and offer Jon some support right now, having lost a son to this illness in a most unexpected way.


How I Cured My Personality Disorder Without Even Trying

…Quit going to a psychiatrist! And voila: Borderline-be-gone!

(Yuk yuk)

Seriously, since he took a vacation and I went off that fucking Cymbalta, I’ve been feeling really good. Not manic too good, but just okay. I’ve evened out. I still wake up sometimes at 3 AM, but I don’t wake up sobbing and wanting to just die. Mornings are hard, but some coffee gets me going and it gets better as the day goes on. For god’s sake, I even am running again – and I guess I also have the shrink to thank for the fitness I’ve lost over the last 9 months. I’m smarter at work, back on my game, not looking like an idiot. Getting along better with people – patients and even the wang doctors.

Problems are starting to not seem insurmountable, even if they are big, even overwhelming at times.

And two things that always happen when I start to rise out of a depression happened: one, I wanted to read e.e. cummings again – the thankful, God-love poems, and two, I had my reflexive horror at how low I had been.

The second thing always happens when I finally come out of a depression. At some point, I’m so thankfully glad to be alive that the realization that I actually considered suicide becomes as horrific and unthinkable as if I had considered murder. When the episode finally has passed, leaving me wrung out and wan, but alive, I can never quite recapture the state of mind in which suicide would have been an option.

This weekend on cable, Of Mice and Men, the one with John Malkovitch and Gary Sinise was on. The moment that caught me was when the woman is dead, with her neck snapped, and she’s just limp, lifeless. I thought of all the horrors I have seen in my medical career. It is hard to describe the feeling that came over me – mostly a massive distaste for the ugliness of death, for the strange limpness and stiffness of a body. When I think that this is what I had, not long ago, wanted to do to myself, a wave of sickness washes over me.

Now I’m faced with the task of moving on. The other day, I was writing the millionth patient note, and writing the date for the millionth time, and I realized that it is almost September. What began as a month’s experiment, and became three, and then six, is now almost nine months of crazy. Nine months of life lost.

This is another thing I think I hate about the shrink: no appreciation for this. He sees me alright now, and doesn’t understand that just because I am okay now doesn’t mean that there was no fallout, no structural damage. Just like back in one of those other freak drug experiments in the Spring, I had a two or three week block of being okay, and he said there was no reason I should delay starting a new job, no reason to take another month to catch my breath. There are few people on earth less willing to take a “sick role” than I am, but can’t anyone understand that I possibly have a right to feel bad about those nine months? Nine months is a long time. Enough time to make a new life from conception to birth. 1% of an average lifespan.

* * *

Here’s another question for the readers: a couple of weeks ago, we had an inpatient, young guy, with a chronic disease which he let get totally out of control, most likely because of depression or some other psych issues. He’ll probably end up pretty fucked up physically out of neglect.

Once when I examined him, I saw a small X-shaped scar on his wrist. Not deep, really, just one small cut X. If it had been a suicide attempt, it was a lame one. If nonsuicidal self-harm, well, also looked like a one-time thing.

I wanted to ask him about it. But it wasn’t really relevant to the stuff I was treating him for, and if I asked and all that, I’d have to document in the physical exam and, knowing how docs view anyone with anything less than perfect mental health, I didn’t want him to have to carry that on his medical record forever, to be judged by ever single person who would ever treat him. And I think I really wanted to ask him just because I was curious.

I, if not made obvious by the previous paragraph, have never self-harmed or really even seen much of it from a medical perspective. But from a lot of the blogs I read and those who link here, I see that it is incredibly common.  So I guess I’m just asking: if it were you, do you want your doctor (not necessarily psychiatrist, who has to) to ask? Or would you rather they politely ignore it?

Off All Meds, Cymbalta Withdrawal, and Waiting for Disaster

The shrink took a vacation (oh, August, the shrink vacation month…could anything be more irritatingly stereotypical?), thus leaving me with the worst physical withdrawal I could imagine. Seriously, could heroin be worse than this? The lesson out of all of this: never, ever quit Cymbalta! For the past few days, I have been having complete autonomic failure. The idea is to go back on my good cocktail, sunburn be damned. Then maybe try lamotrigine. So my skin can all fall off, you know.

The first morning that the withdrawal started, I got the day off on the right foot by arising at my usual crack of dawn hour and promptly passing out. Due to this, I was two hours late to work, which resulted in my being yelled at for another hour and a half.

Follow that with random attacks of true vertigo (walking down halls of hospital – suddenly I’m totally off balance and everything spins), vomiting, shivering, diarrhea, and sweat flashes, and that is quitting Cymbalta in a nutshell. Every time it starts back up, I take a little bit, just so I can function. I have to open the capsules, use the little pellets inside. It is like cutting lines, but a lot less fun, and, I suspect, much more ridiculous.

But – I can sleep, god, sleep after weeks of no sleep, nightmares, and waking up sobbing and suicidal at 3 AM every single night. No more scrounging through Lear and Pale Fire for consolation. This is what the shrink called improvement. Because I was nice. Last time I was in his office, he kept going on about the nice pleasant conversation I was making. I was chatting about nothing because honestly, I was too depressed and suicidal and sick of myself and my misery to even carry on about it. I did what I always do – faked a happy face. But do I really need a shrink for that?

Although the drug did take a certain edge off. Last night I yelled at the partner for overwatering a plant. All of that kind of rage had disappeared. I suspect, though, that that was due to the massive amounts of Valium he had pumped into me to try to fix the sleep problem.

I also totally lost it on a patient the other day. True, the patient was particularly nasty, but on the other hand, was also terminal (I did not know this at the time). After this, I called the shrink (before he left) and told him I was not fit to practice, that he would need to write me some sick days. Mostly wanting to get off to his holiday, he said fine.

But I didn’t call in sick. Arbeit Macht Frei and all that. And I would feel damaged and broken forever and never forgive myself if I ever called in sick over mental illness, no matter how severe.

Everyone around keeps asking me what the hell is wrong, at work, that is. Today I finally made some vague allusions to health problems and let it go at that. It always makes me uncomfortable when people show a personal interest in me, are nice to me. Somehow, I feel better keeping things cold and bastardly.

Despite the horrible physical withdrawal, the suicidality has dropped way off, I can actually sleep, I am somewhat interested in medicine again, learning a bit as I go along seeing patients – opening books, asking colleagues. Today I ran, realizing that I lost almost all my physical conditioning in these last few months. I feel alive. Soon, I hope that feeling of coming back to life, of rising from the grave delighted and full of energy and thrilled to the core, flirtatious and funny and fun will be back.

I am also perversely glad that if I slip into mania, the shrink will not be around to witness it and insist on more drugs. It has been so long since I could write, want to fuck, feel alive at all…I don’t want to quite give that up, no matter what the cost. I need, from time to time, to remember who I am, what I want, to know where I am unhappy in my life.

I also realized, holy shit, it is almost September. I realized that this episode, the idea of changing meds, has been going on for almost 9 months. At first it was a month lost, then three – a season, a delayed start at my new job, and now I am 9 months down the road, having been through hell, sicker than I have been in five years, with no end in sight. This is terrifying. How much more of my life will I have to sacrifice to this cruel master? Soon, it will be a full year, another lost year. I do not want to be sick. I want to be me, thorny and obstinate and moody. I do not want to spend my life in a psychiatric-drug-induced haze. Even if it means I am a bitch. Is that so wrong?

And now that my old self, the one that can save herself, is back…well, now I’ll finally be ballsy enough to quit this stupid shrink. Which, of course, is a sign that I am not medicated well…

How the fuck did this get to be a blog only about therapy? That fucking blows. No more of this. I need my life back. I need my pen. I need my cunt. I need blood.

On further reflection and the rest of the story

Today in the light of day, I still had the kick in the nuts feeling about it. But I made an appointment to go back…and just chill out. And explain why I feel so fucking betrayed. I did realize that part of it is just like what my father used to do to me. He would, for example, be fine one minute and then you trust him and open up, but then what you say comes around to bite you in the ass, which is probably why I am so fucking closed off to begin with.

Example: one time, right in junior year or so when people start getting college catalogs I ordered a bunch from all kinds of good art schools. So I sat with my father (sorry, hard to call him Dad or something, as I always call him by his rather distinctive first name) looking at them, one time, when he was nice and not crazy. A nice father-daughter moment.

Then, two nights later, he was beating the shit out of me because I had considered going to art school and not medical school. If that cannot make you crazy, then what can?

In short, it felt like the shrink did the exact same thing. I was honest, and it landed me a manic-depression diagnosis. More honesty – borderline.

After he said that, there was just no way I could even focus on anything else. I went home feeling horrible (managed to score 30 valium off him at least because he felt guilty).

But then I thought – say I quit therapy. What would happen? I’d have a lot more money, and stop thinking about how miserable and fucked up I am all the time. And guess what? That felt damn good. I told myself that that was it. I went to look at some travel magazines for the first time since I started going to the shrink. I looked at some aviation catalogs (another hobby).  And then my partner came home, and I had a nice evening where we enjoyed each other’s company, also for the first time since I’ve been to the shrink because I stopped thinking about how many bad things there are in our relationship. I had a good day at work even. Enjoyed just being with colleagues, patients. In short, I went back to feeling and functioning the way I did before therapy and the med horror.

So once again, why the fuck am I going to therapy? It is without doubt making me worse. First the manic depression thing, then this all.

I just don’t really believe in therapy. He once again wrangled me into going by sort of suggesting he could get me to stop sabotaging my writing career. Well, nothing like that came out of anything. He made the manic depression diagnosis which caused me an unending amount of grief to try to come to terms with…and now throws another, worse one at me, just as I get my feet back on the ground.

The thing is, personally, when not in shrink mode, I like the guy, so when he says, “You need therapy,” I really believe him. Even though the last time, four years ago, it was the exact same thing. And last time I absolutely promised, swore to myself not to fall for “therapy” again.

And it isn’t even the borderline thing. I am not stupid, I’m sure I have some borderline tendencies, maybe even a lot, and probably with how I’ve been medicated lately, you could make a good case for schizoid as well. The thing that bothers me is that, if he decided/knew I wasn’t manic depressive, and that the thought that I was was causing me great grief, why not, oh, say something about it? It’s the dishonesty that bothers me more than anything.

Another reason I have trouble opening up to him is that, god help me, I feel sorry for the guy, and it’s hard to throw my shit on him. He’s one of those depressive types too…and not always, but a lot of the time, he’s barely going through the motions. He has that stench of the misery of someone who went into a psychoanalytic institute and actually took all that shit seriously. I get the feeling that I want to just stop everything and say, “Oh honey, tell me what’s wrong.” Which is not surprising, given my job / personality / overdeveloped sense of empathy. But I can’t tell him that because he’d just blame transference or projection or some other bullshit. So I’ve been closing myself off to pretty much any of his wavelengths, otherwise I wouldn’t be able to dump all my shit on him.  And that can’t be a good relationship for a therapist.

And for my usual dose of irony: I went into his office totally suicidal that day, miserable, restless, thinking there is NO WAY I could come out feeling worse…

The whole reason I bothered to write this here is that, though this blog isn’t widely read, sometimes I write something and then get emails from a lot of people who, say, are diagnosed borderline who want to comment. Once, I wrote something about shrink troubles, and surprisingly, I got a deluge of emails from psychiatrists, telling me to speak up. So I’m putting this out there, asking for advice. Worth trying to salvage something here, or not? Should I say that his burnout has made me hold back, or is that just going to kick me in the ass? Anyone? Comments or email – either would be appreciated. I go back Thursday, but can move that if I’m still undecided. I wasn’t going to go back at all yesterday, now, not sure. Thought there might be something worth saving or at least trying to close out politely.

Psychiatry claims another victim

…or Dona Juana falls for it again.

I have been having a really horrible week. So horrible, in fact, that almost every night on call I get to a point where it is difficult to avoid thinking about suicide seriously…climbing up to the top of a tall building and jumping. I have been inconsolable. I haven’t really been able to talk about this to anyone. Just…all I can think of is the relief I could have from being me.

I wonder what happened to the version of me that was okay. But I know. Therapy happened.

Now, today I had to see the shrink again. I mentioned that I hadn’t been feeling well, that it had been difficult for me lately. I did not go into detail about the chronic suicidal thoughts and so on. Figured it would come up if it would. I went into the appointment knowing that I am in desperate need of some kind of relief, comfort – maybe a med change, definitely a little support…and also knowing well that I wouldn’t find it there.

Finally, I just asked rather simply, “What the hell is wrong with me? That I have everything and can’t just live.” I also may have mentioned how it seemed like being in therapy – again, his idea, not mine – seemed to just be making things worse. That instead of living my good moments and enjoying them, I was stuck on monitoring my feelings all the time, noticing pathology everywhere.

His answer to what was wrong with me: “I don’t think anymore that you have bipolar. It’s a personality disorder.”

This came out of nowhere, though I guess deep down I knew somewhere not to trust him. This is after letting me spend over a year mourning the fact that I had been diagnosed with bipolar disorder, taking that to heart, coming to see myself as broken and learning to live with that. All, of course, on the basis of his diagnosis.

I didn’t think it would be possible to go into that appointment and come out feeling even worse than I already did. But he did.

I just feel sick and betrayed. Someone who encouraged me to trust and trust – despite my better instincts – encouraged me to do talk therapy, despite the fact that it only caused me harm in the past, was so dishonest with me, never would have even told me unless I pushed for an answer, and even then couldn’t be honest enough to name the name.

The most horrible part: his solution was to increase the frequency of therapy.

No, wait, that’s not the most horrible part. The most horrible part is that I was reasonably happy with my life until I went back to him in late winter. Now, thanks to all this therapy, I’m back on the same med cocktail I was to start with after losing months of my life to the misery of many unsuccessful med changes, and am an absolute fucking mess.

So when they ask how therapy is harmful, here is my story. I feel okay, and that gets me a bipolar diagnosis. I spend a long time in mourning, trying to come to terms with that. It hurt. Then the so-called helper decided it wasn’t even a right diagnosis and actually did not even intend to tell me that.

I am out several thousand dollars, at least six months of needless suffering, and once again, cheated by psychiatry.

This wouldn’t be so bad if I hadn’t been through the same thing four years ago, promised myself to never, ever go back to therapy, for these exact reasons, and then walking into it again. Six more months of wasted time, wasted money (money is a big worry for me), and most of all, personal hurt and dashed hopes. I can certify that I came out of therapy worse than I went in.

For a while, when I quit last time, part of what I promised myself was that if I felt the urge again to go back to any kind of therapy, to immediately go out and spend the cost of a session on something that would give me pleasure. It made me feel infinitely better than therapy ever did.

So now, after another painful and expensive lesson, I am back to where I was four years ago, with additional hurt, in a fairly severe crisis with nowhere to turn, and with no med doc to fix this shit. And a new, deep wound to add to it all.

I probably should go out right now and buy myself something nice with the value of a session. But I’m too fucking tired, too fucking full of wishing for death, for relief. Of course, now I can’t even kill myself, because that would just be some crazy borderline manipulation.

God, I promised myself then never to do this to myself again. Back then, I said to myself, this is it. No more therapy. No more money and time and hope in a dead-end. No more subjecting myself to the judgment of some of the most fucked-up people on the planet. No more looking for relief, for humanity, for help, where there is none to be found. I swore to myself deeply then to never go back.

I guess with time, the reasons I was so adamant got blurry. I managed to forget. Managed to buy into all that crap about how people in that profession really care, are committed to service. Are sensitive. Are empathetic. May even care about patients.

So now, I am out a drug provider. And I am, if anything, worse off than I was this morning with no hope in sight.

I’ll probably call Jake. Just to get reassurance that I’m not personality disordered, a touch of real life, real people. The things that psychiatrists shy away from more than anything.

Thanks for listening, whoever is out there. And if you learn one thing from me, it’s this: don’t go to a fucking shrink. And if you do, never trust one.

Psychiatrist woes revisited

As I said, I’ve been trying to get along at least superficially with this shrink, because I don’t think he’s stupid, which is a lot to start with. Trying to trust his judgment, though I do love the comment someone left on here about med adjustment having the feel of an eighth grade science fair.

This last appointment kind of upset me, because I think it is reflecting that underneath the quiet demeanor and all the right attitude, there’s a lot I really don’t like. I am not totally sure if my problem is with him specifically or psychology as a discipline.

The issue, or at least the one that really is eating at me, is this: I mentioned some work I have been doing in a free clinic. I mentioned and talked about a patient I really liked there recently, how she has been on my mind – in a good way, a caring way – that I hope she’s doing well. I’m glad I have met her, that my life crossed with hers even minimally, even though I may or may not see her ever again. I found her admirable, living in a difficult circumstance and remaining optimistic and not bitter. This was one of the nice points of my work recently. I’m pretty sure I told this warmly, though also mentioned my embarrassment because as doctors we are not supposed to “like” patients, but rather be cold machines who treat everyone exactly the same, based on algorithms and protocols. I mentioned something about how if I weren’t doing work in that kind of a clinic, I’d never cross paths with someone like her, so even when it sort of sucks to be at a place like that, the rewards can be wonderful and unexpected.

His comment, almost reflexively, was something like, “Of course you’d like her, there at a clinic like that and not one of your patients at the hospital. She needs you; they don’t. Just like you.”

Something about that bothered me. I don’t think that it’s even the question of whether it’s true or not – there probably is some truth to the fact that I’m a caretaker type, and even that I use taking care of others as a reason to keep myself relatively stable. I can accept that.

But there’s something basically ugly in his statement, in the worldview implicit in it. And that’s where I always get back to hating psychology/psychiatry: the idea that anything, any human behavior, no matter how noble, beautiful, intense, or intricate, is always based on pathology. Why view things like that? Does it matter if Dostoevsky wrote The Idiot about his own epilepsy and misery? If Rigoberta Menchu was dealing with childhood trauma and a sense of powerlessness?

I have plenty of horrific qualities – a massive ego, a sense of entitlement and narcissism, impatience – so why take one of my few sincerely redeeming ones – that I have a tender spot for people in hard situations – and pathologize it, make it ugly? It isn’t hurting me, and it isn’t hurting anyone else, might even be helping someone…so what is the point?

What, to someone with an extremely psychoanalytic bent, would constitute a good reason for becoming a doctor? For adopting a child? For writing a novel? There is no acceptable answer, and that’s why I always end up quitting therapy. I just realize, again and again and again, that there are no answers to be had there. The unexamined life may not be worth living; but sometimes the overly examined life needs to stop being scrutinized and start being lived. One could potentially stay on the couch forever. A lot of psychotherapists seem to think that that is a good idea.

And in that bizarre, quasi-religious system, somehow the patient is always to blame. You aren’t allowed to disagree without that being pathological. Say I bring that that conversation bothered me. That I think that that comment shows more about his worldview than anything about me.

Naturally, that’s only because I am denying, reaction forming, resisting.

Sounds as rational as any random religious belief one could choose. I could throw myself into any fundamentalism with as much success. Maybe more, because a lot of fundamentalists in other fields are happy. I don’t believe in belief systems. I believe in science, and rationality, and also hope and tenderheartedness and beauty.

So then I wonder. I know most psychiatrists hate their jobs in the end, they burn out, realize they went into it for the wrong reasons, often go into it because they are melancholy at their core. But I don’t think I want to be talking about anything too personal with someone who sees the world as differently from me as this. Psychiatry is a nihilistic discipline at its core, believing in little of anything other than pathology. That’s why I always tell myself not to waste my time in going back. And somehow, whoever I go to for drugs always manages to sell me the whole package.

I guess that despite my wretched suicidal depressions, my lack of faith in much of anything, my unrelenting intensity and horror at the world, somewhere, deep down, I am something of an optimist. I do think that someday, if we work hard enough, things might not get exactly better, but they can get less bad. I believe in the power of small deeds, kindness, contact with others. Moments of something like grace down here in the mud, moments when despite it all, we look up and see the sky.

Should I mention this? Just quit, find someone else for meds? Because now I doubt I can quit therapy without his ego getting all blown into things and him pretty much firing me.

And why do I end up going back, despite my better judgment and reminders and promises to myself to quit wasting my time, to stop looking for answers from a religion that offers none?

I guess I need therapy to answer that question. (Note the sarcasm.)

Medication decisions

The good post will come later, when I can sit down and translate. This is about the details of the medication possibilities offered me.

When I finally went to the shrink, the appointment was ok, but, as I suspected, he wants me to take lithium. Well, it wasn’t that simple, he gave me a shitload of options, but nothing I really hadn’t looked up myself, and out of all of them, I think lithium is best. I think I decided that before I even went in.


I just feel sort of sick about the whole thing. It was really different to know and have decided in my head than the real moment when he put the box of lithium in my hand. Vitamin L.


It sort of makes me want to kill myself that I get the official BIPOLAR, TAKE LITHIUM; NO FOOLING YOURSELF ANYMORE diagnosis in the same week as Britney Spears.


Another thing that sort of freaked me out is that he thought that ADHD is a huge part of the problem. Now, I can see why he thinks that. I am increasingly scattered in recent years. It’s worse when I’m in his office because that makes me nervous. But I am 100% sure I didn’t have ADD as a kid. I used to be able to sit and read for like 12 hours straight. I can’t anymore, and have increasing difficulty studying, just cannot sit and do it. But I’m sure it’s not ADD, I never had anything like that, no trouble in school, etc.


So I’m afraid that this is wrecking some new part of my brain…that it is getting worse, that I’m losing function. I guess I will talk to him about that maybe next time. The natural history of the disease. Am I going to end up seriously impaired? I think that from what I can tell, psychiatrists are really bad at doing research on large numbers of people – and they have no good answer. A lot of papers out there say, oh, they get worse over time, disabling, etc. BUT now that I have seen how drug company research is done, a lot of the times they make that case to say, “Here, look, it’s horrible, they need to BUY MORE OF OUR DRUGS or something HORRIBLE WILL HAPPEN.”


So here are the drug options he put down, and my ideas about them. I ran this by Jake for another opinion…


1. This was my idea – another tricyclic, similar to the one that I am taking that is doing me the sunburn. He didn’t know if that would do the same sunburn, and as far as I can tell, and I’ve looked in medical lit, no one knows. Possibly, in the pharmacist literature, someone somewhere has written what exact breakdown product of the drug that does that is, and if it is exactly the same for all of the class, or I can maybe gain a few years of not having to take a mood stabilizer by using a different drug and letting its breakdown product build up in my skin and give me these burns, and then even maybe be able to switch back to the other one and let it build up again.


He was not crazy about this idea, because he said, well, look, you’ve been manic a couple of times on it, and depressed more than that, so you’d probably be better off with something else.


Anyway, we left that an open option. He is going to see if he can get an answer, and Jake’s wife is a pharmacist, and through her he knows this clinical pharmacist who only works with psych drugs, and if anyone in the world will know the answer to that, he will…


So I talked to the super pharmacist and he also didn’t have an answer about whether another will burn me too. (This was a horrible conversation for a lot of reasons, sort of a weird guy to talk to, basically told me I was going to crash and burn.)


2. Lamotrigine. This is a new drug from the mid 1990s that started as an epilepsy drug that is also now widely used as a mood stabilizer. Unfortunately, a while back, I found out about a clinical trial sponsored by the company where they tried it in a different disease, and they certainly exaggerated the raw data, spun the statistics to get the drug licensed to be sold for that disease. I’m not naive, I know that this is pretty standard in medicine, and I know that every drug company does that, but I happened to hear about this one and pretty much want nothing to do with it. So I ruled that out. Also, very very rarely, it can cause a horrible skin reaction that can even be fatal. The pictures of that are bad enough to also turn me off.


3. Valproate. Another drug from around the same time as lamotrigine, similar concept, causes weight gain (extreme), and rarely, makes your liver die. I am not as strongly against this as lamotrigine, but I also suspect it isn’t as effective as it is made out to be.


4. Lithium – since it is basically an element (in salt form), no one can patent it or make any money off of it. It has been around for almost 100 years in present form. It has been widely studied. In what I can see from the literature, it is probably the most effective drug out there, but has lots of problems. It can wreck your kidneys. It can wreck your thyroid. It makes you pee a lot, possibly gain weight, retain water, and hands shake. Makes you nauseous. Gives you acne. Needs to be closely monitored because just a little bit too much is highly toxic. Needs to be closely monitored on the kidney and thyroid thing. But – for people who can stand it, it is effective, cheap, and WELL STUDIED. I mean, I don’t think they are going to discover that it makes your brain catch on fire or anything like that. This is always a risk with new drugs.


It has sort of a terrible reputation, but I don’t really think it’s fair. A lot of drug company hype is to say, “What we have is bad, what we are selling now is so much better.” Well, just because they haven’t discovered all the bad stuff of what they are selling doesn’t mean it ain’t there. And I’d rather know exactly what it can do bad than just not know and take something else hoping for the best.


My fear with lithium is that it will take away my enthusiasm – how I can dive into anything and get so excited and feel alive. I won’t take up celestial navigation and astronomy and sewing and everything with as much zeal. Some of the people on the discussion board told me that that is more of a myth than true. It does stop the mood swings, but not the underlying personality traits that go with them.



Also, are these side effects worse than the ones I am having with the tricyclic? The burning under any light and having to live in darkness? The inability to stand up for more than a minute without fainting? The hunger and weight gain? The continuous heart rate of 140? So I’ll fuck up some kidneys and thyroid instead of heart and gut. Is it worse?


And here’s just the real problem for me, and I know this is idiotic, but, the stigma. Vitamin L. I can go get the labs done by going to a lab and paying cash under a fake name, but my family doc, who needs to order the EKGs, the kidney stuff, thyroid stuff etc…is anal about writing things down right in files…would write down something like, “Ordered for followup for lithium treatment” – and the way things are here, anyone swipes my health insurance card and they see that immediately. As is, I can’t even go to the gynecologist without getting treated like a crazy person (which, I guess, I am, so fair enough).


By the way, no one knows how any of those three work. So, no guesses by mechanism of action what might work.


5. Duloxetine (Cymbalta) – this is a new drug that is sort of like Effexor. It is like an SSRI but also works on noradrenaline, like the tricyclics, but is structurally unrelated. Serotonin and noradrenaline reuptake inhibitor. My big problem – it has been on the market for 2 years. Despite heavy marketing, to me, it doesn’t look like it does much more for people than Prozac or Paxil when I look at the published data, of which there is not much. Again, there is the issue of 2 years on the market, doesn’t look like a wonder drug to me, despite how they market it, and again, there is always the possibility of discovering that it makes your brain catch on fire, fall out your ears, or some other unexpected result. I pretty much ruled this out. Jake said he wouldn’t go near it either.


6. What the shrink really wants – lithium + some antidepressant or other. I’m against this, just because only the tricyclics didn’t make me stupid, and apparently I can’t take them, or if I can take a different one, why the lithium then? And if the lithium will curb the moods, why the antidepressant? Also, I’d rather not pump more chemicals into my poor, abused brain than necessary.

At the very least, finally facing this a little more has been good in that when I woke up hysterical in the wee hours of the morning, as has been happening for months now, I managed to write the outline for an essay about this…it really flowed like things do when I write well, I think I am going to go with the metaphor that came to me in the night. I think it’s a good metaphor, I was so goddamned determined not to end up like them, but I didn’t know the name of the monster that was chasing me. Invoke the magic of knowing something’s name.