Non-compliance

Doctors often look at their manic depressive patients as being non-compliant. Like we’re being difficult on purpose, stubbornly denying the route to good health.  If manic depressives only took their medication they’d be OK, they’d be able to control their cycles of highs and lows.  Yes, well maybe so, but its just not that simple.  It never is.  If health care providers could walk a mile in their patients shoes they might be more sympathetic.  The reason I don’t take long term medication is due to the fact that every long term medication has had worse side-effects than my disorder has me au natural. 

I have tried several medications for controlling my bipolar disorder, including Lithium, lamotrigine, seroquel, abilify and other antidepressants not appropriate for me.   I can tell you about my personal experience on each drug, keeping in mind that everybody tolerates side effects differently. 

1. Lithium is the standard mood stabilizer prescribed to most bipolars.  It is clearly effective in stabilizing mood swings and preventing suicide in manic depressives. It also has a long list of side effects that many people have to endure.  I tried lithium twice. Gave it an honest to goodness fair shot.  The first time it gave me the awful tremors. They were significant enough to impact my life, so bad that I was accused of forgery at the bank.  Embarrassing to explain.   The second time (4 yrs later) it caused extreme drowsiness, fatigue, diarrhea and gas.  I could barely get off the couch and when I did manage to get up and go out my gas was so bad that I scared people out of the aisle in Shoppers Drug Mart. I was mortified.  There are some things that are just too disrupting to ones lifestyle that the side effects are too much to endure.  Lithium was not for me, my doctor agreed.
2. Lamotrigine gave me a rash that would have potentially led to a fatal complication. Thus I had to cease my therapy under my doctors advice. 
3. Seroquel, even at the lowest therapeutic dose, turned me into a zombie.  I would not wake to my alarm clock.  A bomb could go off next to my head and I doubt I would even notice. I would be late to all my appointments. I could not find the spoons in the kitchen when getting breakfast. Etc...  All this was too much for me.  I will not be zombified, I like being alert and aware of my surroundings.
4. Abilify is the most recent drug I have tried and am currently taking. It is an atypical anti-psychotic medication and has helped me through my latest mixed episode of agitated depression.  It was fast acting (within the first week I noticed improvement) and I am tolerating this drug fairly well except for 2 side effects: tardive dyskinesia (a movement disorder causing involuntary facial muscle spasms) and blurred vision.  During the first couple weeks I never noticed these side effects but after the third week it became obvious that both these side effects would impact my life.  I have a tendency now to purse my lips and make a small squeaky sound.  It is controllable when I think about it, but if I don’t it is enough to annoy the people around me, e.g. those next to me on the subway cast dirty looks at me. I can deal with this though side effect although my doctor is more concerned that it risks becoming a permanent quirk. The side effect that is more bothersome is the blurred vision.  It is definitely affecting my quality of life and is the reason I am considering terminating the course of treatment when I can safely do so according to my doctor (which is 6 weeks symptom free while medicated, I am now at 4 weeks since I have had any symptoms from my last episode).  I play sports and my depth perception is poor.  I often have difficulty seeing long distances now. This is not good for athletes. It also makes me squint when I watch TV or read. But it affects my social life because when I can’t see the faces of my friends I feel embarrassed and tend to just isolate myself rather than admit to my friends that I can’t see well. This is incredibly frustrating for someone who brags about having 20/15 vision after lasik. Social isolation is not good for bipolars.  I’m not sure how long I can tolerate this particular side effect as its not getting any better over time like I had hoped. 
5. Valporic Acid (e.g. Valporate, Divalproex, Epival) is the most recent drug that my psychiatrist is pushing on me.  Undoubtably, like lithium, it has a proven track record for mood stablization, however, it also has a long list of side effects (I won’t list them all here in the interest of time, you can read the lengthy list on its website if interested).  The fear that is stopping me from taking Valporate is that 15% of patients report hair loss.  Now also that means that 85% of bipolars take it well.  The specific problem I have is that a close relative who is also bipolar and has taken Epival in the past endured significant hair loss which she has never fully recovered - from despite doctors saying that when you stop taking the medication your hair will grow back so no worries. Lies.  I have many of the same tolerances as this relative thus I am hesitant to take the risk.  Although it is extremely superficial I would be devastated by losing my hair.  I am a young pretty vibrant woman and I am unwilling to risk losing my hair, sorry.  Women need nice hair more than a good mood. That’s life. 
6. There is one more major mood stabilizer (besides lithium, lamotrigine and valporate)  that has been recommended for me if I do not choose to take Valporate - this is Carbamazepine (e.g. Tegretol). However, there is often significant weight gain associated with those who take Tegretol and I refuse to even consider this.  My psychiatrist actually agreed with me in this regard.  Considering my history he knew that this would be problematic for me.  Escorts in particular don’t gamble with hair loss or weight gain. 

Hopefully this has given you a brief yet general understanding of the ordeal I have been though when trying to stabilize my moods using drug therapy.  I honestly gave each drug a try, taking it for several weeks solely and objectively before making a judgment call on how it affects my mood disorder and my lifestyle which is undeniably another significant component of emotional well being. 

So what is a bipolar scorpio woman to do when all the drugs that are supposed to help her mood chip away at her body and soul in the meantime???  

In my most recent assessment my psychiatrist said that I am “ambivalent about basic steps to achieve mood stability”.  I strongly disagree.  I care very much about achieving mood stability and exploring the drugs that could help me, but I also care greatly about maintaining a standard quality for my life.  I have not yet found a balance using medication. Its only the moments between episodes I suppose I feel balanced.  But do I always need to be balanced? That’s a little boring isn’t it?