Hope for an Intractable Situation?

August 30, 2012 7:17 AM

I am in what seems to be an intractable situation, due to a number of major errors on my part. Help needed for someone on the edge of a precipice.

I am 35 and for the last two months have been living with my parents for a few complicated reasons. I had a manic in the spring. Medication fixed it, and I felt basically ok until a depression set in, which was due in part to me slightly decreasing the medication too soon. (The medication, lithium, numbed my feelings and thoughts, and I gradually decreased in the hopes that these things would come back. This was mistake number one.) I re-upped the dose, but the depression continued, and was joined by insomnia and severe sleep deprivation. During this time, my intellectual and emotional capacities dwindled to the point that I felt essentially unable to cope by the end of June. I didn't get proper help during this time, which probably would have been adding an antidepressant to the medication I was on-- this was mistake number two. I was prescribed medication for sleeping; they made me feel confused and anxious.

During this time, my emotions disappeared entirely, and my ability to think clearly and intelligently (I have a chemistry degree from a fancy university and a graduate degree in philosophy) went away as well.

In late June, I moved to my home state and in with my family. After essentially 2 months of sleep deprivation, medication changes, and depression, I felt cognitively shut down, emotionally numb, and very very unlike myself. I essentially felt like a new personality had worked its way into my head, and that I'd lost the person I'd known up to this point.

Also disappeared: my planning and memory skills, my ability to focus, my interests, hobbies, and desire to be with friends. I feel like my past happened to someone else.

At home, I saw a new shrink, who decided to add an antidepressant, and I followed this regimen for 5 weeks, during which time I continued to have severe sleeping problems and feel intellectually squashed, and like a different person, w/o thoughts and feelings. After 5 weeks of no improvement, I decided to wean myself off the meds. That was two weeks ago-- I continue to feel the same.

I am worried that there is permanent damage to my brain.

Up to this point, I'd been keeping my parents in the loop about what was going on-- they'd been incredibly supportive/worried this whole time, and were a major source of help to me during the mania and afterwards. I knew they would freak out about me stopping the meds, so I didn't tell them, until last night. They said essentially that if I want to continue to stay at their house and have their support, I have to go back on medication; otherwise, I'm out. They're also justifiably angry and feel betrayed that I didn't tell them what was going on.

As far as I see it, all my options are dead ends. I felt horrible while on the meds (lithium and prozac) and not sleeping. The other medication the psychiatrist suggests (Lamictal) has side effects of cognitive dulling and sleeplessness because it works by inhibiting electrical activity in the brain. I'm already incredibly dulled and sleep deprived. The option of doing nothing, as I am now, means I'll continue feeling unlike myself (slow, unable to think and be myself, and missing the essence of my personality and emotions) and also be w/o a home and family support.

I feel I have lost or am in the process of losing everything -- my mind, my family, my sense of self. My friends don't know what to do or how to help and are exhausted. I've had self-destructive thoughts because the situation seems intractable, and I have strong suspicions that some damage has been done and I'm never going to feel like myself or be able to do the things I was able to do again.

It feels like a hopeless situation, and I don't see a way of it getting better. I can try a new medication and see if it helps, but if it doesn't, and I go off it, my family will be outrageously angry again.

I was not "mentally ill" before this incident this spring. I've been productive and happy most of my life. Now it feels like my mind and life are in shambles. Is there an option I'm missing? I've read forums on hopelessness where folks have said that just because you can't see a solution doesn't mean that one doesn't exist. I can't see a solution.

posted by anonymous to Health & Fitness (20 answers total)

It feels like a hopeless situation, and I don't see a way of it getting better. I can try a new medication and see if it helps, but if it doesn't, and I go off it, my family will be outrageously angry again.

Why do you assume you'll go off the medication? Assume you'll make your best effort and keep your family as fully in the loop as possible. (Your family sound like they are angry, but they are protecting their own boundaries which is potentially good in terms of their stamina for dealing with this problem along with you.) You're in a terrible terrible phase of being by polar but people do stabilize all the time and you do have help so don't lose hope.

I'm sorry this is happening to you.
posted by BibiRose at 7:22 AM on August 30, 2012

The medications you tried aren't the only ones available. Instead of going off them completely, TALK TO YOUR DOCTOR and have her/him adjust or try new ones. The situation isn't hopeless; many people who are diagnosed with bipolar disorders live very happy lives once they are stable on medication--this is entirely possible for you, too. But only if you are willing to consult your doctor, rather than just stop medication altogether without medical advice.
posted by so_gracefully at 7:30 AM on August 30, 2012 [4 favorites]

Can you find a different psychiatrist who is willing to work with you more to find the right meds? It seems like these aren't working for you if they have side effects that are interfering with compliance.
posted by needs more cowbell at 7:41 AM on August 30, 2012

Aren't you the poster who asked this question last week? Aren't you basically asking the same question here? Have you acted on any of the earlier suggestions?
posted by drlith at 7:42 AM on August 30, 2012

Absolutely get your doctor involved and feel free to say, "I don't want to be on medication that dulls my thoughts and emotions. Is there anything we can do? Are there other medications or other therapies that might help?"

Your brain will trick you into believing that you are acting rationally when you are not. Going off of psychotropic and anti-depressant drugs can be devastating if it's not done under a doctor's care.

You are lucky that your parents are understanding and I think you appreciate their intervention and help. Be sure to acknowledge and thank them!

My anti-anxiety drugs dull me a bit, and I haven't written a word on my novel in quite a while, but let me tell you, I don't miss anxiety attacks, no one little bit. There are trade offs.

Please make an appointment with your doctor to discuss your meds and how to make safe changes. If your doctor doesn't seem to want to help, seek a second opinion.

For now, trust that your parents and your doctors have your interests at heart and work with them to get you on the right path.
posted by Ruthless Bunny at 7:44 AM on August 30, 2012

Here's the thing, it is NEVER a good idea to change your medication without talking to your doctor about it. There are lots of different medications that all do things in different ways, and if your current ones aren't working, you tell your doctor, and they will work with you to adjust things.

If you want things to get better, you NEED to tell all of this to your doctor right away, and have them help you to adjust your medications until they work. You should also be completely honest with your parents about what is going on, and let them help you. You say that you knew your parents would freak out if you told them you were off of your medication, and that would be the correct reaction.

You need to accept that in your current state, you are not the best person to make decisions about your medication. Let the people who have a clear outside perspective help you to make those decisions. It seems like your family is very supportive, so let them help you. It is no one's best interest for you to ignore their advice, or the advice of your doctor. In the long term it is going to make things worse.
posted by markblasco at 7:44 AM on August 30, 2012 [2 favorites]

It isn't your fault you are ill, but it is your responsibility. I like the comment below, that any support network you have must FIRST be medical help (including med compliance) and only then can your secondary support network (friends and family) be effective. You have not tried many medications, it is not unusual to have to try many different ones until you find what "fits". And forget about googling side effects, that is you rationalizing away using medications. Everything in life has a side effect; you have to responsibly weigh the risks and rewards after being informed, and when it comes to pharma you do have to trust your doctor with their years of education and experience may have more relevant knowledge than your Internet reading. It can get better, with proper medical help you may need to advocate. This may be a good time to bring a family member or friend closer into the loop and accompany you to dr's appointments to advocate for you.
posted by saucysault at 7:46 AM on August 30, 2012 [2 favorites]

I'll just jump in and say that Lamictal doesn't always have dulling side effects. I'm on it, and I have no side effects whatsoever, which is not something I can say for any other drug I have ever been on. It's worth trying. I don't think I've ever seen a side effect profile for a psych med that *doesn't* include that kind of thing, but obviously not all of them do it to everyone.

Do not fear the Lamictal. It may not work for you, true, but it does work for me, and it certainly doesn't do horrible things to everyone's brains.

I'm such a booster for this stuff. They should be paying me. (They're not.)
posted by Because at 8:45 AM on August 30, 2012

It's tough for smart people to be mentally ill. You've been right about things your whole life, so why not now? But you're making it plain that you're overruling your doctor and making your own decisions about medication, which is making your problems worse. If you honestly don't trust this doctor, get a new one. But you have to tell your doctor *everything* - how you're feeling, what your opinion is about medication, etc., etc.. *Then you have to do what they tell you to do*. If you change your meds and don't keep your doctor in the loop, you are sabotaging your own recovery.
posted by facetious at 8:52 AM on August 30, 2012 [2 favorites]

You don't mention the context of where you are in life, other than your prior academic training, but it stands to reason that you have lost a lot of life in this process of having a breakdown and moving back in with parents. The right medication will improve the neurotransmitter environment in your brain, but if you have had huge changes like moving and returning to a child-parent dynamic (and presumably aren't working), then there is a lot of important stuff in there that has affected your sense of self and your sense of reality.

My suggestion would be to try to get a good therapist and start thinking about what kind of life you want to rebuild for yourself (place to live, work, friend and family relationships). Friends and family can give advice, but you don't want them to be your therapist, you want them to be your friends and family with whom you can rebuild healthy relationships.

Also, agree with all other advice above about not going off meds without discussing with your doctor.
posted by artdesk at 9:22 AM on August 30, 2012

Psychiatric drugs take a wide array of different times to build up or clear out of human bodies. It can sometimes be unpredictable. That's why you need to talk with your doctor about how you're feeling and why you want to change about how you're feeling. No matter what your fancy degrees, internet research skills are not an effective replacement for a trained, specialized doc... though they CAN assist you and your family in advocating for change (take the article, ask that it be considered).

Personally, I had to try lots of drugs before I found the ones that work for me. And the time you spent on (on off) the drugs doesn't sound like enough to really give them a fair chance or your body.

Fuzzy-headed ness, sleeplessness, tiredness... IANAMD but those can all be signs of depression. If you think it's something else talk to your Docs about it.

BTW I don't think that psych meds are a panacea. They wont necessarily make a huge difference all by themselves. What you do with your body matters just as much as what you put in it. Exercise, even just walking 20 minutes a day, can improve your mood. Mindfulness meditation has been shown to have a massive positive effect on mood. Helping other people can improve your mood. These are all things that work for me. Even though it's hard to remember and harder to do when life seems like it's the pits, ultimately drugs + action make a difference.

Let your parents help & the ultimatums will probably become less rigid. They are likely really scared, I know mine were.

I hope all the advice doesn't feel overwhelming. All you need to take are baby steps.

Best of luck.
posted by Heart_on_Sleeve at 9:26 AM on August 30, 2012

I want to second Because on Lamictal. I'm doing just fine getting a PhD and I sleep about 10 hours a night; I've been taking a normal dosage for 2+ years.
posted by munyeca at 9:27 AM on August 30, 2012 [1 favorite]

Just want to say that whenever it is perfectly clear to me that things are hopeless and intractable and that there no options, it is a sure sign that my depression has worsened. I recommend that you stop paying attention to your own conclusions about the matter and just see them as the symptoms that they are. It is absolutely normal for people to go through multiple rounds of failed medications and tweaking of dosages before their depression is alleviated. You are doing yourself a huge disservice by taking these matters into your own hands. Let your doctor know in detail what is and isn't working for you and let her devise the strategy. It's a frustrating process, but most people do end up with something that works.
posted by Wordwoman at 9:34 AM on August 30, 2012 [3 favorites]

Here to add weight to the "try other meds" brigade.

I took Citalopram for a while (related to prozac) and felt very similarly to how you describe. Came off it and felt hopeless. Got prescribed a different antidepressant, in the tricyclic family - it changed everything.

All meds are different, you just have to keep trying, as if you broke your leg and are trying different kinds of physio to see which works best to get you walking again.
posted by greenish at 9:49 AM on August 30, 2012

You have received some great suggestions here and in your last post, kellybird had some excellent points for you.

I suggest that you take a couple months off from doing your own medical "research" as I think that is really feeding into your anxiety right now. Go back to your doctor, tell him/her what you are feeling and how the meds made you feel. Tell him/her about any other remedies you are trying and supplements you are taking and then get started on a new drug program that you follow. Should you feel its not helping, go back and tell the doctor. This will be a long road but there is very likely a med(s) out there that will help. But it may be hard work to get there and needs to be done with a trained medical professional (not Dr. Google).

Everything from your posts all indicate that you are still dealing with depression combined with the after effects of Lithium (which can take months to pass) and sleep deprivation. The lack of sleep alone could be the complete cause of your feelings of apathy and disconnection from the world. Sleep is a HUGE part of cognitive function.

Good luck.
posted by saradarlin at 10:15 AM on August 30, 2012

After essentially 2 months of sleep deprivation, medication changes, and depression, I felt cognitively shut down, emotionally numb, and very very unlike myself

...I decided to wean myself off the meds.

Do you see the problem here? You yourself mentioned you're not up to par intellectually at this moment and yet you decided to wean yourself off? I'm not playing the blame game - simply to illustrate that you're not in any shape to make such a decision.

Neither are you in any shape to make projections that the problem is intractable and that all your "options are dead ends."

Do you see what I'm trying to say? For lack of better words, in your current exhausted and depressive state, your brain is ACTIVELY LYING TO YOU! It is telling you stuff that is not true (that you're at the end of your options) and you're not in the proper state to know any better.

As for meds, at this moment in time, lean on someone who does know better and can make the proper judgment, i.e your doctor/psychiatrist. They need your help in evaluating the efficacy of the medicine but as for dosage, type, etc - they're the experts. Again - you're not in any shape to make that decision at this point. Even when you're at your best. Let the experts do their job.

Good luck to you.
posted by 7life at 10:24 AM on August 30, 2012 [1 favorite]

The other medication the psychiatrist suggests (Lamictal) has side effects of cognitive dulling and sleeplessness because it works by inhibiting electrical activity in the brain.

It MIGHT have that effect. It never had that effect on me and I was taking 300 mgs at one point. This feeling that it will inevitably not work out? It is the depression talking. Try the lamictal.
posted by the young rope-rider at 6:34 PM on August 30, 2012 [1 favorite]

I hear you. Your life has completely gone off the track. That's what happened to me when I had a first-time manic episode at age 27 which was luckily controlled quickly, but then was followed by a soul-killing depression: I didn't work for 4 months and saw a therapist three days a week while I battled depression. My meager daily goal was to leave the house for at least 30min a day.

I was terrified that I'd never work again, and that my life as a productive member of society, holding down a job, having a social life, was effectively over. It wasn't. Just remember that it just feels that way, but it is absolutely 100% untrue.

I did a trial of every single antidepressant and mood stabilizer that existed at the time (I won't go into the list). Nothing worked until one day something did. Unfortunately, that's how it is with bipolar disorder. A psychiatrist friend of mine mentioned that probably it wasn't even the antidepressant that worked, but my depression finally abating. That's the good news: even though it doesn't feel like it, the depression will lift. It always does.

Please don't be discouraged (believe me, I understand you completely, I have absolutely been where you are right now), please be reassured that you don't have brain damage. This is the depression talking.

Please understand that your parents have your best interests at heart, and taking your meds, working with a therapist, eating well (go omega-3 and blueberries!), exercising (even if it's a mini-walk around the block) and seeing a psychiatrist regularly are all building blocks that work together to slowly lift you out of the depression.

Reading _An Unquiet Mind_ by Kay Redfield Jamison, helped me tremendously, YMMV.

Hang in there, trust that you are getting better, try not to beat yourself up (I know, a tall order) and treat yourself like a precious object, because you are.
posted by Pocahontas at 9:16 PM on August 30, 2012 [1 favorite]

I just want to say that things will get better. I don't think your brain is permanently damaged. It's a very hard time in your life, but this is a important learning process for you. I have been through similar situations, although in a much lighter degree. At that time, all I think of is try to get out of this mess, to be well again or at least achieve some small goals I set for myself. But I keep failing that too. Until I took sick leave, I allowed myself to rest. I wanted to do volunteer work, then I got connected to good old friends, did volunteer work, then got a new job. Things start to pick up very quickly. Read books, find out how other people do transition. admit that you are human, allow yourself to fail, open yourself for grace.... take care.
posted by akomom at 9:29 PM on August 30, 2012

I took lamictal for a few months for seizure-related reasons, and I felt incredible on it (as in, I went from feeling secretly suicidal to taking very good care of myself and thinking about possible futures). I didn't feel dulled at all, in fact I tried all kinds of new things, started exercising, and reading more, etc. I also felt like it helped me reorganize my thoughts (which was an unrelated bonus), and even after I went off it, I feel like I learned some things on it which continue to persist. And this is all coming from someone quite anti-medication. None of this is to say that you wont experience any side effects, and it's smart to monitor things closely and stay aware of how you are doing, but I feel very positively about my experience, even on a very low dose.
posted by thegreatfleecircus at 5:16 PM on September 2, 2012 [1 favorite]