At least I'm not that guy

I have been hurt a lot by the psych conditions I have, they've affected every area of my life. At least I don't have to deal with what this guy did.

Counseling might be difficult

I have no idea how counseling works. I went to my second regular appointment today, before that, I'd had two intake interviews.

I think that counseling might be difficult. The last time I went, I was sad for five hours, I counted, and I wasn't even thinking about the stuff we talked about. It's been four and a half hours since my appointment today, and I'm hoping the sadness lifts soon.

This sadness feels very physical. My mind isn't whirling or anything. I'm not obsessing over any thoughts. I feel soreness in my legs, my throat hurts, I feel tension in my head, a headache like I got before I started wearing glasses. I just took two ibuprofin.

I know I shouldn't drink right now. I want to. I know it would be bad. I'm not drinking, but mainly because I'm on Clonazepam, and I hear that just a little alcohol will get me very tipsy. I have to grade a lot of papers tonight. Pity those students!

I feel this bad sometimes, with no obvious cue. It's entirely possible that my sad mood right now is, you know, my regular depression.

I don't know if it's a coincidence, or if the counseling is digging up deep stuff. It's funny, because I pretty much just talk for my 45 minutes, and sometimes my counselor asks a question or suggests something, or frowns sympathetically. I have deep, honest conversations with friends frequently, I'm very candid, and some are insightful enough to dig very deep and find difficult things for me to deal with. Maybe it's that I see my counselor as an authority figure, or that I see counseling as a special time, or maybe my counselor has some sublimely deep insights that don't seem as deep as they are when I hear them, but bother me later into working out some subconscious issue.

I have no idea. Maybe it's just a coincidence that I feel exhausted right now. Maybe I'll be in a positively chipper mood after the next session. Or, maybe I'll feel miserable after the next session, but maybe that's what getting better feels like.

Deescalating

The hardest thing about a hypomanic episode is the time after it.

It's tough enough to have grandiose delusions, thinking things like, "I'm the best scientist in the world." Except, I can actually feel like that if I'm pulling all-nighters and writing crazy code and impressing my advisor. Sometimes, I do really great work when hypomanic, but enough of the stuff I make when hypomanic is either crap or so pathologically egotistical that it's useless; on the whole, I don't think that hypomanic episodes are worth it.

What's tougher is the time after the hypomanic episode. It's a huge let-down. When I'm hypomanic, I come up with all sorts of crazy plans, ideas for great books, how to do awesome science, how to get more Twitter followers.

I'm a meticulously organized person. I have two baskets of unfolded laundry in my room, sitting on top of a disgustingly sweat-stained pillow and dirty sheets that I never intend to use again. I normally have a pile of dirty dishes in the sink. However, when it comes to information and ideas, I track everything. Right now, I'm reviewing my 100+ projects that I have in my system. It's sad for me to see some of the projects that are really, "How can I pump up my ego?" It's satisfying and freeing, though, to delete them.

Clonazepam is amazing

Benzodiazepines rock. Or, at least, Clonazepam does. I've been feeling anxious all week. It was weird, it felt different from my regular sense of anxiety. I felt very taxed, very preoccupied, like I couldn't catch my breath, except I didn't actually have shortness of breath. When I was heading out to start my day on Wednesday, I just sat and listened to podcasts and played solitaire on my Palm Centro.

Ordinarily, when I feel anxious, I feel a sense of fear about all sorts of things in my life, "I'm inauthentic", "I'm afraid of paying bills", "What if I run out of money?", "I'm not a good grad student", "God doesn't like me". It's normally a pretty cerebral experience, but, hey, I'm a pretty cerebral kind of guy. Of course, there are physical effects, too, I tend to oversleep to cope, that's the big thing. I'm less attentive, I'm more likely to goof off at Photobomb than to actually do my job.

Exercise helps a lot. I love going for half an hour on an elliptical machine, then doing some weight training. However, this takes a lot of time, I need to get into gym clothes and pack soap and a towel, if I want to exercise in the middle of the day. I haven't been to the gym in a couple of months. I take a lot of walks, now; whenever I need to burn off steam, I can wander by the pond for fifteen minutes and get back to work. Half an hour of walking a day is way better than two hours at the gym once every two weeks.

The anxiety I've felt this week has been different. I grind my teeth. I can assess how anxious I've been over the past couple of days based on how large of a lesion I've worn in my right cheek. My cheek had been healthy for the last month or two. This week, the lesion was huger than it had been in maybe a year or two. I felt very physically tense, a lot of tightness in my belly and I was getting tension headaches. I was twitchy. I always carry Silly Putty for if I get fidgety, I was using it a lot this week. I would wake up an hour before I had set my alarm, and have trouble falling back asleep, I was tossing and turning. This is all very unusual for me; anxiety is normal for me, but this felt like a more basic, physical anxiety.

I've been taking Lamotrigene for two weeks now; it's a mood stabilizer, and it's the first thing I'm trying to manage my bipolar disorder. One of the potential side effects is anxiety. I was wondering if it could have been the cause of the anxiety this week. I had been on 25 mg for the first two weeks, which is, in the words of my psychiatrist, Dr Regan, "practically homeopathic". Dr Regan is gradually increasing my dose; the Lamotrigene won't do anything useful for another six weeks, or so. The dose is being increased very gradually because the medicine can cause all of my skin to "slough off" if I'm allergic to it, which would lead to "death".

I had an appointment with Dr Regan yesterday, Friday, but I was feeling so bad on Thursday that I tried to call him anyway, to see if I should back off on the Lamotrigene. I knew that it was unlikely that it was making me anxious, but the anxiety felt so different from my normal anxiety that I wanted to make sure. I couldn't get in contact with Dr Regan, so I called my primary care physician, Dr Murthy.

Let me digress. I would like to say that I'm wildly enthusiastic about all of my doctors that are helping me. Dr Murthy has been my doctor for about two years. She's not chit-chatty, but she's very compassionate. Also, she's a vegetarian, and so am I, so she can help me make sure my diet isn't troubling me. She works in Glen Burnie, but is so good that I think she's worth the drive. I can get you her contact info if you're looking for a doctor.

At any rate, Dr Murthy suggested that I skip the dose on Thursday night, just in case, and talk to the psychiatrist on Friday.

In our regular appointment, Dr Regan said that there was no way that the Lamotrigene was causing the anxiety. He proscribed clonazepam, which is an anti-convulsant. Most benzodiazepines are pretty addictive and can cultivate dependency, so they should only be used in emergencies. Clonazepam is great because it's long lasting, but with no euphoric high. It's safe to take long-term. I can't drink, now, though, because alcohol interferes with it very strongly. I enjoy wine, so, hopefully, when the Lamotrigene kicks in, I won't need the Clonazepam.

The Clonazepam is amazing. I was having trouble not being panicky yesterday, but, today, I feel calm and serene. I sleep ten hours last night, but I had been pretty tired, so I'm not sure if it's the meds or what.

For the past week or two, my anxiety and depression had been pretty tough for me. Curiously, I could concentrate very well doing my job. That concentration blocked out the pain. I reckon that I've worked 57 hours this week, which is a lot more than normal for me. Whenever I wasn't actively talking with people or writing code or grading papers, I felt terrible, not because I felt compelled to do these things, but because it was only when I was concentrating, flowing, that I could feel free from the anxiety and depression. This isn't healthy, long-term, I want to work because I love work, not because I hate doing anything else, but there are worse coping mechanisms than advancing human knowledge and helping train the next generation of engineers.

I'm still confused as to why anxiety felt so different for me this week.

Lexapro broke me of a lot of the negative thought patterns that I had. I normally have very cerebral experiences of anxiety, depression, and hypomania. This got so bad on Lexapro, I had to learn how to just feel terrible, instead of feeling terrible and thinking terrible, too. I've been listening to a lot of Zencast lately. I don't have a regular meditation practice, or anything, but I've been learning to cultivate mindfulness, learning to be more embodied. I used to have anxious thoughts. Now I ask myself, "What does it feel like to be anxious?" and I observe how I feel in my body, tightness in my belly, soreness in my limbs, whirling energy, and so on. I wouldn't put a lot of money on this, but I wonder if mindfulness practice has helped me change my experience of my psych problems, and maybe that's why anxiety felt so different this week.

I feel so not-stressed now, thanks to the clonazepam, that I feel like I'm on vacation. I'm sitting at an outdoor table at Panera with a cup of coffee and a bagel. I'm looking at a parking lot. When I feel okay, though, I can take a vacation to a parking lot.

Psych update

I've not written much about my psychiatric problems since about mid-August. I finished taking Lexapro, an SSRI that I was proscribed for anxiety, on July 31. If you've read most of the stuff I've written so far, skip down to New Stuff. Otherwise, here's a

Handy Review

The first few weeks on Lexapro, in late June, I had become very depressed, anxious, and sleepy. But, after the first few weeks, I started having delusions and feeling very up. I describe some of this in Bad Lexapro.

I was brought to the point of realizing that I have depression in addition to anxiety while I was on the Lexapro. In How psychologically healthy Lexapro made me, I describe how this realization happened: Lexapro made all of my regular problems, depression, anxiety, and a whole slew of negative and harmful thoughts, it made them huge, so I was forced to admit that they bothered me. I don't know if I was in denial about having depression, or if I just didn't know what it felt like, to have an undepressed mind, but my depression became so bad while on Lexapro it made the depression the rest of the time seem more obvious to me. I decided to get help for this problem, too.

In Anhedonia, I describe still feeling very affected by the Lexapro, a month later. In fact, I don't feel like I landed until about a week ago. I feel more normal now, but not totally normal; I feel very affected, mentally. Frankly, I feel scared.

New Stuff

At the end of August, I decided to get counseling help. At UMBC, there is free counseling offered by the University Counseling Services. I now have been to two intake sessions and one regular counseling session with Dr Wick. Dr Wick is a new counselor with UCS, but she has twenty years of experience, including three at Goucher. I feel like she has a good understanding of the context my life is in as a grad student; heck, she's been one herself!

I was initially reluctant to ask for counseling help. I could write a whole post on just the bad thought process in that, but I didn't want to admit that I have trouble just knowing how to manage my emotions, at a thought level. I'm a smart person, I'm working on a PhD, I get good grades, I read smart books, but that doesn't mean that I am as good as I'd like to be at telling when the things I'm thinking about myself and my feelings are reasonable or harmful.

Wednesday of last week, I went to Dr Regan with UCS; Dr Wick had referred me to him, he's a psychiatrist. Dr Regan is one of the coolest doctors I've ever been helped by, he reminds me of Tom Gammill, smart and pleasantly sardonic. He diagnosed me with bipolar disorder. I didn't believe it at first, because I've never, say, raced my car along country roads at 4 in the morning, or spent a week rearranging furniture.

As I understand it now, I fit the bill perfectly for bipolar II. Bipolar I is the really tough bipolar disorder, with the wild mania and deep depression. Bipolar II never hits the DSM's definition of manic; my experience from mid-July to mid-September or so does count as hypomania. Bipolar II is tricky to diagnose, because a patient could complain of the doctor, never have had a hypomanic episode, be proscribed an anti-depressant, and then get shot high. Antidepressants like Lexapro are great for depression, but without a mood stabilizer, are terrible for people with bipolar disorder.

My terrible experience with Lexapro is the classic litmus test for bipolar II. I'm so glad to have a concrete diagnosis now. It'll be a while before I can look at getting medicated for anxiety specifically, but that might be treated along the road with mood stabilizers and antidepressants.

Dr Regan proscribed Lamotrigene, a mood stabilizer with few side effects, except for a deadly rash that could result in "the outer layer of my skin sloughing off". That doesn't sound too bad, compared to hypomania. I've been on it for a week now. I have to gradually increase the dose, so it'll be a while before I feel any effects.