I’ve taken Zoloft on and off (but mostly on) for over eight years. If you’ve read the posts Philip Dawdy made last month or last week about an article in The New England Journal of Medicine, “Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression,” or read this news article about it, you know that this study shows that antidepressants aren’t effective in treating bipolar depression.

Okay, so you probably could have figured that out anyway.

At this point, I am taking Zoloft for two reasons:

1. I’ve mostly been feeling good since I started taking meds again, so I don’t want to screw with my medications in case Zoloft is helping me avoid depression.
2. Some medications have made me extremely tired. Since Zoloft does the opposite, I assume it is helping me wake up in the morning. I have trouble falling asleep, but I wake up and I can function. I think it’s balancing out any drowsiness that my Epival might cause.

I don’t know if either of these are valid long-term reasons to be taking Zoloft, but they’re good enough reasons for me in the short term.

Zoloft is the only SSRI I’ve ever taken, but I took Effexor in January and February of 2006. Three weeks starting on it, and then three weeks coming off it. See, I was taking it all by itself without a mood stabilizer or an antipsychotic. I had gone off all of my medications in the fall, felt fine, then got really suicidal really quickly and wound up in the hospital. The psychiatrist on the unit discharged me with a prescription for Effexor although I told him I didn’t think it was a good idea for me to take an antidepressant without a mood stabilizer.

He told me it would be fine, and I figured I might as well listen to the doctor, because stopping all my meds all by myself hadn’t worked out too well for me. I was also not thinking very clearly and it didn’t occur to me that this could have more dire consequences than a mild hypomania followed eventually by another depression.

So what happened? Well, I once read the phrase “rapid cycling/mixed state hell” on an online forum, and that describes it perfectly. I don’t feel like going into any detail today, but suffice it to say that I wound up back in the hospital exactly three weeks later. It wasn’t pretty. It was, in fact, really ugly. I mean the situation, but come to think of it, the hospital was ugly, too.

I’m sure my being bipolar rather than unipolar had a lot to do with that in my particular case, but we all know that you don’t have to be manic-depressive for antidepressants to make you flip out. So it’s nice that the FDA has finally ordered updated black box warnings on antidepressants “to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment (generally the first one to two months),” whereas the warning only applied to those under 18 before that.

Health Canada had already issued a warning about this:

Health Canada is advising Canadians that Selective Serotonin Re-uptake Inhibitors (SSRIs) and other newer anti-depressants, now carry stronger warnings. These new warnings indicate that patients of all ages taking these drugs may experience behavioural and/or emotional changes that may put them at increased risk of self-harm or harm to others.

The new warning for each of these drugs, which are listed below, appears in the information package received by patients and in the prescribing information available to health professionals.

Patients, their families and caregivers should note that a small number of patients taking drugs of this type may feel worse instead of better, particularly within the first few weeks of treatment or when doses are adjusted. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others…

That’s from a press release issued June 3, 2004.

It’s a bit different, though — it applies to all ages, not just people under 25; it includes harm to others as well as self-harm; and it doesn’t include all antidepressants, just newer ones.

Welcome to Rapid Cycling. Population: me.

(The image above is a magnet I have on my refrigerator.)

Lately I have been up-down-up-down-up-down. Usually rapid cycling is a February-March-April thing for me, and I start easing out of it around this time of year. Susan at Bipolar Wellness Writer recently wrote two good posts about seasonal aspects of depression and manic depression, Ebbs and Flows and Seasonal Affective Disorder. I can relate, as there is definitely a seasonal component to my illness.

I tend to have an overarching mood pattern of being very depressed from late September to early February, then hypomanic/manic until mid-May, then relatively normal or mildly hypomanic until late September. But I also tend to have cycles within cycles, especially in the February-to-May cycle. Then I often bounce from euphoric to dysphoric hypomania (and occasionally mania) to depression and back again, in random order, for random periods of time. The spring is my prime rapid cycling time, but that doesn’t mean it never happens at other times of year. I usually feel good during the summer, but sometimes I have episodes of depression then. I’m usually depressed during the fall and early winter, but sometimes I’ll be Doing Just Fine or I’ll have brief periods of hypomania.

For nearly five months, I have been Doing Just Fine with some ventures into mild hypomania now and then. For the past few days, though, I have been up and down frequently. I know some reasons why, of course. My current jobs have very variable hours and I don’t do so well when I’m not following a stricter schedule of sleeping and eating and working and leisure time. My problems with finding adequate treatment have also been frustrating me lately. (Experimental Chimp does a good job of blogging about his struggle to find adequate treatment, by the way.)

You ever notice that if someone already has you tagged with borderline personality disorder, then any time you admit that an actual life stressor is affecting your mood somehow, it’s seen as further confirmation that you have BPD? I know there’s supposed to be a “marked reactivity of mood,” but aren’t manic-depressives, or, God forbid, even people without any psychiatric diagnosis, permitted to have some reaction to things that have actually happened to them? And when some of those things are clearly physical reactions rather than psychological ones, too? It’s not rocket science that I’m going to be more unstable when my eating and sleeping and general living patterns are irregular.

Just an observation. I mean, I know that I currently don’t make a strong case for my own point at all, as my extreme rapid cycling as of late is actually typical of someone with BPD. I mean “extreme” in the sense of frequency/length of episodes and not at all in the sense of the behaviour that I am exhibiting. The most “extreme” I’ve been behaviour-wise lately was that Tuesday I cried a bit, and only the mental health nurse saw it the first time and nobody saw the second time.

At this very moment, I feel great, just so you know. At this very moment, I can’t imagine being depressed about anything. Don’t you love how even in the middle of rapid cycling, somehow I manage to firmly believe that whatever mood state I’m in is permanent?

I love Stephany’s post Who is a mental health advocate? Read it.

If you know where the title of my post came from without having to Google it, then I love you.

Apparently, in this town you only deserve to see a psychiatrist if you’re in crisis. I guess there’s no such thing as seeing one every three months just to check in.

I didn’t actually get to see a psychiatrist today, but that didn’t surprise me. What did surprise me was that the mental health nurse I saw thought there was no reason to refer me to a psychiatrist, even though that was what my GP had requested. My GP had, in fact, requested a specific psychiatrist.

I have been completely stable for months now. I feel better than I have in years. And this is the problem. I feel fine, my medications are working for me, I finally have a GP in a nearby town, and technically I have a therapist but I only saw her twice, in January, because bus service near their office is very limited and I can’t really afford $16 for a cab there and back.

I filled out some forms and then the nurse asked me some questions for about half an hour. Mainly very basic stuff — describe my family, how is my relationship with my boyfriend, what is my level of education, what medications am I on, etc. She asked me about being assessed at the hospital in the fall, and she mentioned that the particular shrink who had seen me was going to be at the mental health centre that day. I looked at the door, kind of freaked out, as if I expected to find him walking right by, right then, because I kind of did. But he wasn’t. She clearly has a higher level of respect for him than I do, and I’m pretty sure she’s going to get my file from the hospital so she can see what he thought of me. And presumably believe him over me. Yeeha.

She asked me if there was anything about my life that I was unhappy with and wanted to change. I said there wasn’t anything, really, only that I’d like to be a bit less shy and a lot more organized, and that sometime I’d like to work on issues related to past trauma.

“What kind of trauma?” she asked.

“I was raped twice.”

“How old were you?”

“Twenty and twenty-one.”

She asked me how that currently affects me. I told her that sometimes it makes me sad and scared. She asked me if it affects my relationship with my boyfriend, and I said, “Only that it makes him worried about me.”

Then she changed the subject.

I definitely didn’t want to bring up the eating disorder thing. I was afraid she would think I was overreacting.

The mental health nurse said that the only thing she was worried about was my level of anxiety. She didn’t believe me when I assured her that I was only anxious because of the appointment and that I don’t usually have anxiety problems (which was true), but she said it was to up me to decide whether I thought it was a problem I needed to do something about.

“I don’t think it is a problem,” I said, “but I’m open to other interpretations. If I did have an anxiety problem, what should I do about that?”

“Well, we have an Anxiety and Mood Disorders Group,” she said, “but they just had their last spring session. It should start up again in the fall.”

The fall? WTF? It’s a good thing I don’t have an anxiety disorder. Imagine if I actually had one and I asked what I should do and she told me to come back in the fall. I can only hope that they have other anxiety disorder treatment options and she just didn’t feel like telling me what they were.

I hate how I’m going to keep replaying this appointment in my head, over and over and over again, wondering what I did wrong and what I could have said differently so that I could have actually gotten some help. I don’t know what I should have asked for. I don’t know what I should have said that I didn’t say, or what I did say that I should have left out.

Fuck! Fuck! Fuck!

I hate this town. Hey, last week I was looking at buttons at a record store and they had one that said “I hate this town” on it. I’m totally going to buy one and put it on. That’ll make me feel better.

When in doubt, shop.

I left the appointment thinking, I wish I were dead, I wish I were dead. Then I came home and cried for a while. It was kind of nice to cry. I’ve been so stable and so genuinely happy that I almost never cry anymore. And I’m very used to crying, so it feels kind of weird not to do it anymore.

but i’m a modern woman baby
ain’t gonna let this get me down
i’m a modern woman
ain’t gonna let this get me down
gonna take my master charge
and get everything in town
~ Nikki Giovanni, “Master Charge Blues”

Gah, even when I’m not talking about Virginia Tech, I’m still talking about Virginia Tech.

Not really “everything in town,” though. Just that little pin, and some books (which I have gift certificates for), and THE NEW TORI AMOS CD. Must. Go. Shopping. I don’t even have a MasterCard, by the way.

Haha, I was just checking my email and the web clip near the top of the screen in Gmail is Ask Yahoo! - Who invented the shower? It’s there because I went to a wedding shower the other day and a couple of my recent emails mention that, but it’s still funny.