I got my prescriptions filled tonight, so I am hopeful that my stupidness from medication withdrawal will go away soon. Seriously, it’s not good when you’re sitting in the doctor’s waiting room reading a poster on the wall about signs of Alzheimer’s disease and realizing that you currently have most of them. If my attention span improves soon, then I’ll be able to post more, as well as read other people’s blogs and respond to their posts. You would not believe how many times lately I have read other people’s posts, clicked on “Post comment,” and then completely forgot what I was doing and never got around to actually posting a comment.

There’s a Wired article called Anakin Skywalker: Borderline Personality, Bipolar or Narcissist? that I found via stir-crazy, they found via Mind Hacks, and they found via Omni Brain. I’d especially recommend reading both the Wired story and the Mind Hacks post.

I only have a few comments to make:

1. Hee.
2. Hey, I’ve been told I have bipolar disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder, just like they’re saying about Anakin Skywalker. This can mean one thing, and one thing only: I AM DARTH VADER!
3. The article reminded me right away of a humorous article I’d read years ago in the Canadian Medical Association Journal, “Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne”, so I was extremely happy to see that the Wired story linked to it.

Admittedly, though, I don’t actually think I’m borderline, and I know I’m not histrionic or narcissistic.

According to the authors, who reported their findings at the American Psychiatric Association’s annual meeting in San Diego, Skywalker meets the criteria for the condition: He has difficulty controlling anger, stress-related breaks with reality (after women in his life die or leave), impulsivity (dangerous pod racing), obsession with abandonment (those women again) and a “pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation” (hello, Obi-Wan).

In another sign that he’s borderline, the authors argue that Skywalker suffers from an “identity disturbance.” After all, he did become Darth Vader after being “very unsure of who he was and what he wanted.”

I don’t have difficulty controlling anger, obsession with abandonment, an identity disturbance, or a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation. I am impulsive and have had stress-related breaks with reality. Well, I can live in hope that those two things are enough to MAKE ME DARTH VADER, can’t I?

What is the best treatment for one who has been drawn to the Dark Side of the Force? The opinions of professionals are mixed:

Study co-author Bui said psychotherapy — “long term,” he added with a laugh — would be the best treatment for Skywalker, although he might prescribe a drug to help him sleep.

Bui had mixed feelings about prescribing an antidepressant like Prozac and said he’d avoid tranquilizers like Xanax that could leave Skywalker addicted or send him into “disassociation” (a rupture with reality).

But would Skywalker even go into therapy? “Because of his narcissistic tendencies he would perceive himself as ‘above’ that,” said Sultanoff, who thinks Skywalker also suffers from narcissistic personality disorder, at least in Star Wars Episode II.

I’m going to assume that by “disassociation,” Randy Dotinga means “dissociation.”

Not that there’s much point in trying to help Anakin at this point. He’s dead, yo. Remember?

thememoryartist recently made an excellent post, A new proposal for the DSM, which “outlines and categorizes the features of Mental Health Professional Personality Disorders.” It’s funny because it’s true. Which also, of course, makes it sad. I’ve seen plenty of mental health professionals whose behaviours and attitudes are outlined very well by those criteria.

In a comment, Gianna mentioned that the post might be educational for mental health professionals. I’ve met some MHPs who would appreciate it very much… but they’re not the ones who tend to exhibit any of the listed behaviours. I think the ones who actually exhibit the “symptoms” would see that piece of writing as an example of a patient being narcissistic and overly hostile, and would never recognize themselves in the criteria.

There are also a lot of interesting comments on this post about PTSD misdiagnosed as BPD.

I am doing okay physically with the Zoloft and Epival withdrawal. I didn’t even have any of the brief dizzy spells yesterday. I was, however, staring at a word on a computer screen when I saw it suddenly jump several inches to the left, even though this did not really happen. I am hoping that this is just a regular hazard of the twenty-first century, as opposed to a withdrawal thing.

As I mentioned in a comment on my last post, medication withdrawal has made me kind of stupid lately, though. I can’t remember anything, my attention span is even worse than usual, and… um, I already forgot what I was going to write in the last part of this sentence. Oh, yeah, I’m constantly almost late for stuff. Since none of this has been interfering with my work performance, it’s not really all that important. It just bugs me.

Tomorrow I get to see my GP and I hope I’ll get my prescriptions. I have to pay forty freaking dollars for the cab ride there and back, because there’s a shortage of family doctors here, no bus service to the neighbouring town where my doctor is, and I don’t have a car.

The main annoyance that is occurring since I am currently off my meds is that I’ve been having very brief dizzy spells. I also have even less of an attention span than usual. It’s hard to settle down and read books or web sites. Disorganized, forgetful, etc. My mood is very good, though. Except for when it isn’t. It happens suddenly, without warning, and goes away suddenly, too, and the rest of the time I am quite peppy.

It turns out I shouldn’t have been sulking about my one-day weekends, because next weekend I personally get a zero-day weekend. It’s not as if I have to work eight hours every day, but still, it’s just nice to have an entire day where you know you don’t have to be at work for any of it.

I am thinking that I should be more Organized and learn how to Manage My Time, so maybe this will be my newest obsession that I will research, and maybe I will try systems and labelling and colour-coding and be very gung-ho for a month and then forget about it. Or maybe it will work. You never know.

I haven’t been around for a while. I’ve been trying to use my scant amounts of free time lately to do things like reading, crafting, and interacting with people offline. I am bummed that most people around me just had a three-day weekend and I had a one-day weekend. I am not physically tired, but I still wish I had some time to relax lately, which I don’t. I am also so disorganized that I didn’t really notice that I was running out of my medications, and I won’t be able to see my doctor and get my prescriptions until next Thursday. I am used to having doctors who will phone in prescriptions, but since my current GP doesn’t, calling my doctor when I had three days’ worth of medication left was as useless as calling after I’d run out completely. I’m on such a low dosage of Epival that I don’t know if it’s possible for anything horrid to happen to me if I abruptly stop taking it for a bit, but I’m taking those last three days’ worth every other day instead of every day, just in case that will lessen my chance of suddenly having a seizure or something. I don’t have a seizure disorder, but stopping Epival cold turkey can make people have seizures even if they’ve never had one before. Whee.

Everybody has already read about this study and its claims that there is something called “subthreshold bipolar disorder,” and as far as most of us can tell, SBD equates to “simply being human, but big pharma thinks you need antipsychotics for it anyway.” I’m lazy, though, so I haven’t commented upon it until now.

CL Psych posts about the incredibly loose criteria for SBD and the media’s claims that there is “appropriate” medication for it in Subthreshold Bipolar: The Giant Sucking Sound and Subthreshold Bipolar: Media Blitz and Lilly.

Philip Dawdy has also written several posts about subthreshold bipolar disorder, including Name The New Bipolar Disorder, in which he urges people to come up with a better name for SBD. I haven’t come up with anything yet, or rather, I haven’t come up with anything that no one else hadn’t thought of and posted already!

I am vastly confused by the stats from the article in the Archives of General Psychiatry. No, they’re not too complex for me to understand; they’re too stupid for me to understand. Only a 2.4% prevalence of Americans who, twice in their lives, meet half of the criteria for hypomania? I would expect it to be more like 99% than the 4.5% it winds up as in this study once you add the 2.4% to the 1% prevalence for bipolar I and the 1.1% for bipolar II.

I am more of a fan of the bipolar spectrum than some people in the blogosphere are, but this subthreshold nonsense is taking things way, way too far. Honestly, sometimes I like the things that Akiskal has to say, and he’s one of the authors of this study. Some doctors overdiagnose bipolar disorder, and most people who diagnose it overmedicate their patients. But there are still plenty of health care professionals who don’t recognize bipolar disorder. Sometimes, it’s not their fault — they don’t see the patient when he or she is hypomanic, and even if they do ask him or her about past symptoms of hypomania, the patient, in the middle of a depression, is pretty much unable to remember ever feeling okay, let alone hypomanic, and doesn’t — can’t — answer accurately.

Then sometimes there are shrinks who think you’re not manic-depressive if you haven’t, like, married someone you’ve just met and then bought five cars. Doctors who think mania equals euphoria and if you’re having a dysphoric mania, you’re just an asshole. Who think that mixed states or rapid cycling must always be borderline personality disorder instead, and even, believe it or not, doctors who are always going to assume that if you’re psychotic, you’re schizophrenic.

Yes, this “subthreshold” stuff is ridiculous, but within limits, I like the idea of the bipolar spectrum because it makes people aware of things that actually are bipolar symptoms but aren’t necessarily the most classic ones. It’s when you start pathologizing mild things that occur infrequently that it gets to be harmful.

No, I don’t know where the line should be drawn. But I’d say somewhere way before “subthreshold bipolar disorder” as defined in that journal article, anyway.

I have to take my Zoloft with food. If I don’t have enough food with it, I get this horrible feeling in my throat, like choking to death, only I can breathe okay. I realize that this description makes no sense unless you’ve had the same feeling yourself, but that’s what it’s like. It’s not exactly pain, but it’s extreme discomfort. This particular discomfort feels a lot worse than some things that cause actual pain, and when I experience it, it’s all I can think about until it goes away, which usually takes about two or three hours.

The first time this happened to me, which was over eight years ago, I didn’t know what was going on and I was terrified that I was going to stop breathing and die. Luckily, when it happened again the next night, I quickly figured out that I should probably eat more food when I take my Zoloft. This was a completely random guess, a shot in the dark, but it turned out to be correct.

Occasionally, the amount of food that is generally enough to prevent the choking feeling will not work, and I will still be in extreme discomfort, despite having eaten the same amount that I usually do before I take my Zoloft. Tonight, I ate more than I usually eat before taking my Zoloft. I ate more today than I’ve eaten on any other day in the past two months, without throwing any of it up, and I was all proud of myself for my progress with the eating disorder thing. I ate lunch. I ate supper. I ate a good-sized snack and then took my Zoloft and Epival. And I still feel kind of like I’m choking. It’s not as bad as it usually is when it happens, thank goodness. Moderate discomfort as opposed to extreme discomfort — if it was the extreme choking feeling, there is no way I would be able to type this right now.

When I have a really bad night with the choking feeling, then I really don’t want to take my meds the next day. Or any time in the near future, really. There’s all this trepidation and uncertainty. Usually, I eat something and take my Zoloft and I feel fine, but other times, I eat something and take my Zoloft and feel like there’s a giant hand closing around my throat.

Does this happen to anybody else? I once had a doctor tell me that this side effect that I was experiencing did not exist. If he traded esophagi with me and took some Zoloft without food, he would never say that again.

Philip Dawdy’s post Texas Teen Commits Suicide After Taking Lexapro contains a link to a streaming video of a newscast. At one point in the news story, the dead girl’s father talks about how Kayla was going from highs to lows, typical of most teenagers. Then the newscaster’s voiceover says, “But when the highs became higher and the lows lower, a doctor placed Kayla on Lexapro.”

Now, it’s very likely he could have gotten this wrong. The media gets quite a lot of things wrong. But if he’s right, and Kayla was vacillating between abnormally low lows and abnormally high highs, then it’s not just Forest that her parents should be thinking of suing. Prescribing an antidepressant alone for someone who shows signs of being manic-depressive is criminally stupid, especially if you don’t provide them with adequate information and follow-up care.

I am tired of tragedies happening to families all because of people who should know better, or who should care, and don’t.

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.

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.