The Diagnosis

Once I started to get over the Ex, my summer depression started to lift. As it got closer and closer to the start of school, my mood lifted correspondingly. I stopped going to bed at 7:00 at night (although whether that counts as “night” is debatable, especially because it didn’t really get dark until 9 at night anyway). My marathon training started to pick up and I started to get faster and stronger. The once daunting and stomach-sick, nerves inducing 10 mile runs became challenges I was increasingly eager to take on. I stopped spending so much time in bed, looking out my window on the second story of the house, wondering what would happen if I just let myself fall out.

And then it was time to go back to school. I’ve always liked going back to school, and being in school in general. I’m an extrovert and I thrive around people. At least I used do. But by the time school started again I was feeling pretty good. But I hadn’t forgotten about my despairing depression that occupied the majority of my summer. I was already on the maximum dose of my antidepressant and I wanted to see if adding in something like Abilify would keep the darkness at bay, and maybe something like Xanax for my anxiety, if I was lucky.

I trotted into Student Health and saw the doctor who had been renewing my antidepressant script and asked about adding on something new. Apparently, as a general practitioner, she wasn’t supposed to mess with meds that much and so she sent me upstairs to the Counseling Center.

The Counseling Center*. I had avoided counseling and therapy up to this point and I had absolutely no desire to start now. Apparently at my school, in order to see the psychiatrist, and thus get meds renewed or tinkered with, you had to be seeing one of the counselors in the Center.

(This is the same Counseling Center from “A Warning.” At this point in my story I had no idea how bad my experiences with the Counseling Center would become, but that part comes much later.)

I went through the intake process, which consisted of a very long and comprehensive computer test designed to identify problem areas so that you could be paired with an appropriate therapist. I stupidly answered the drinking questions honestly but lied about my drug use, then limited to occasionally smoking weed, not trusting the confidentiality agreement to keep me out of trouble.

At this point, I was still drinking. A lot. I was that girl who always got too drunk. I couldn’t go out and just have a few, I got drunk-ass wasted. Luckily, I usually wasn’t a crier. Unfortunately, I had a tendency to get pretty aggressive and confrontational. I rarely black out completely so I usually remembered my stupid escapades, although sometimes the details of who I had offended the night before escaped me. I was also a make-out whore. Not a real whore, I was very good at keeping my legs closed, which made me a very effective tease. I was careful to avoid going home with any of my make-out targets, which certainly kept me out of a lot more trouble. By the end of my first year of law school I had made a name for myself as a party girl.

Answering the drinking questions honestly was not such a great idea in the end because it freaked the counselors out. After filling out the computer portion of the intake, I met with a counselor for an initial, sort-of-diagnostic session. After the session, where the counselor would get a feel for my issues and corresponding mental health needs, I was told that the counselors and psychiatrist met and assigned people to counselors. They tried to pair you up with someone who had experience with your unique brand of issues.

I ended up getting paired up with the counselor who did my intake meeting. I actually liked him and it was a good match. Although I still wasn’t thrilled about being stuck in counseling, he did a good job with me and made the whole charade a lot less painful. We got along well and he was from the same area in the South that I am. He was pretty troubled by my alcohol use and wanted me to do an alcohol assessment with one of the drug and alcohol counselors. I didn’t think I had a real problem, and the assessment sounded miserable, so I refused to schedule one.

As school started to get underway, my mood started to lift exponentially. I was out of the snares of my depression and was happy to be alive, trucking onward at an increasingly feverish pace. I attributed my good moods and occasional hyperactivity to the marathon training. I was running tons of miles a week and I was sure that an intense and lasting runner’s high was responsible for my mood.

Not that I minded. I felt like my old self again and it was great to be in a good mood almost all of the time. I kept drinking and getting wasted drunk on the weekends. As the semester progressed I started getting more promiscuous. Which, in retrospect, should have been a red flag. My spending also started to get out of control. I’ve never been great with money but online shopping started to become a real problem. I already owed my little brother two grand and I was putting everything on credit cards that I couldn’t afford to pay off.

I started getting really hyper. I had too much energy for school. I couldn’t sit still, some part of my body had to be moving. I’d always been on the hyper side but this was much worse than usual. At lunch I was talking too fast for my friends to follow and I felt like I needed to run laps around the law school just to dispense with some of my energy, even though I was still in the middle of marathon training. My long runs were steadily approaching the 20 mile mark but the running seemed to do little for my boundless energy. One night I was so hyped up that one of my friends thought I was on amphetamines. And at that point I was more than a few drinks in and had smoked at least a bowl. Two depressants in my system and I was carrying on like the energizer bunny.

It didn’t take that long for my therapist to put two and two together. I went to therapy every two weeks and one Tuesday in October I arrived at my appointment and he pulled out one of those bipolar test/questionnaires. The kind where they list symptoms and you check off the ones you have. If you check off a certain number, like 5 out of 9, then you’re “bipolar.” Well, I checked off a bunch of them. Sleeplessness was one of the only hypomania symptoms I wasn’t having. I’ve always been a big sleeper and I’m thankful for that– I think that’s kept me from getting flow-blown, psychotic mania.

He told me I was probably bipolar. The psychiatrist agreed. They put me on Lamictal and told me to stop drinking. They took my Celexa down to a really low dose– they both agreed that the high dose I was on probably triggered the bout of mania.

And that was it. For awhile anyway. I didn’t tell my parents or my brothers. I told my close friends but the diagnosis didn’t change much about my life.

But I didn’t really believe I was bipolar. I thought it was probably a mistake or coincidence that my symptoms matched up. I’d known people who were bipolar and I didn’t seem like them at all. Sure, I was self destructive, spent all my money, had a heightened sex drive, racing thoughts, started wild projects I’d never finish, and was dangerously impulsive. But that was just the way I was. Surely they had confused my personality for the disorder. I had no problem with my depression diagnosis. I knew I was sad, didn’t have any reason to be, and had no problem taking a pill everyday to rectify my faulty brain chemistry. But to me, being bipolar didn’t seem like a simple brain chemistry thing, the way I had characterized my depression. It felt bigger, serious, and, most importantly, not like me.

I’ve finally started to accept my diagnosis but it would be something that I would wrangle with and resist. That day in my counselor’s office I was in denial. But once the fight began it would rage and burn and nearly pull me down with it.

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14 responses to “The Diagnosis

  • crucianlocs

    I also have been avoiding counseling and therapy. I’ve been trying to find a therapist I like but keep finding reasons not to pick one and its because I’m afraid of the diagnosis I don’t want to put a label on what I have I know I’m depressed and that’s fine with me I don’t want to know what else may be wrong I guess that sounds crazy but that’s how I feel

    • gmercier4388

      That’s not crazy, therapy might not be for everyone and I don’t think I’ll always need it.

      • crucianlocs

        I’m hoping I can continue to avoid it I have a lot of feelings buried deep that I just don’t want to revisit…for now I have found ways to cope with my depression and hide it from others (it makes my family and friends uncomfortable) but one day I know I will have to find a better way to handle things

  • cabrogal

    “They put me on lamictal and told me to stop drinking. ”

    Sigh, P-docs and their scripts.

    There have been several studies into anticonvulsants as treatments for bipolar over the past 10 years and while they aren’t actively harmful (other than ‘usual’ side-effects) like the SSRIs and SNRIs, they’re not particularly useful either.

    Lamotrigine is about the best but its still a case of treat seven to get one positive response. In other words there is only about a one in seven chance of any improvement on lamictal.

    The gold standard for bipolar pharmacotherapy is still the oldest and cheapest psyche med on the market – lithium carbonate. And for someone who is having particular problems with mania, lithium should be the first thing that comes to a prescribers mind.

    But of course lithium earns practically nothing for the drug companies and so everything-but-lithium is probably what the reps tell your counsellors.

    Personally I’ve been very fortunate in not having to resort to psychiatric meds to try to control my bipolar, but if that ever changes I’ll be going with evidence, not marketing.

    All of that said, response to psyche meds – including placebo response – is very individualised. If its working for you, stick with it. If its not, ditch it.

    And don’t confuse withdrawal from psyche drugs with recurrence of your condition. There’s a lot of people on long term medication who think they’re still fighting mental illness but who are really fighting drug addiction. The p-docs will tell you that it can take months for a drug to start helping you but they rarely tell you that it can also take months for it to stop harming you.

    Over the past year they have taken my bipolar grandmother off the anticonvulsants and antidepressants due to cardiac side effects. She is now physically, emotionally and mentally much better than she has been for over a decade, which is a good result for a 93 year old. If they’d done that three years ago she’d probably still be in her home of 65 years instead of in the old folks home. Mind you, she’d probably still be seeing the idiot quack who prescribed them in the first place.

    Withdrawal from psyche drugs can be quite nasty and you should line up all the support you can before trying it.

    “Stop drinking” is pretty good advice though.

    • gmercier4388

      I’ve stopped drinking at this point in my life and I’m on a lot more meds. I’ve just started to get really serious about getting sober and I think that will make a big difference with the meds. I’ve always had some many other chemicals in my system that I haven’t really given the meds a chance to work.

      I’m terrified of lithium, especially of the weight gain and toxicity issues. I’ve gotten off the SSRIs and I’m quite happy about it, even though the withdrawals were a bitch. I can’t make a solid conclusion about the meds. I’m on five different things right now for my various mental issues but I think my psych will eventually eliminate some of those once I stabilize for long enough. Luckily, I have good insurance so most of them are cheap. The lamictal costs me about two bucks for 60.

    • cabrogal

      Occurs to me that the frequent serum level monitoring required for those on lithium may raise its effective cost quite a bit and could be a consideration for prescribers and patients.

      Not being from the US, that’s something I don’t usually have to think about.

  • queenlorene

    I ran from it for 25 years until I started Rapid Cycling. At some point you just have to give in and let people help you if you don’t want to completely ruin you life and the lives of those you love.

    • gmercier4388

      I’ve definitely embraced the meds now, fear of rapid cycling is what keeps me on them when I start thinking about going off them.

      • queenlorene

        Yup, it’s a spiral into insanity– or suicide. Keep on them.

      • cabrogal

        “I’ve definitely embraced the meds now, fear of rapid cycling”

        Its now pretty broadly accepted that rapid cycling with switching (i.e. no gap between mania and depression) is entirely an iatrogenic condition. You can *only* get it from drugs – primarily antidepressants, but some street drugs also.

        Non-switching rapid cycling has also increased in line with increased SSRI prescription and is thought to be largely caused by them. Discontinuation of antidepressants is the most effective treatment for rapid cycling bipolar.

        The STEP-BD study provided convincing evidence that patients on antidepressants not only suffered much higher rates of rapid cycling but also from long term mood destabilisation.

        http://ajp.psychiatryonline.org/article.aspx?articleID=99598
        http://www.medscape.org/viewarticle/495236_3
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922360/
        http://www.theoneclickgroup.co.uk/news.php?id=2958

      • gmercier4388

        I’m just subscribed to the school-of-meds. And especially to the notion that cycles get worse as you go. I know my depressions have gotten worse, I’ve been hospitalized twice this year. After my long manic period I switched over into what has been the worst depression of my life.

        I’m finally starting to stabilize but I’m not in a place to experiment with going off meds, especially because I believe they’re necessary to rectify the brain chemical cocktail that, in my opinion, is at the heart of being bipolar. At least I hope it is. But that’s just my take on things and in my experience, I’m much better on meds than off.

      • cabrogal

        “And especially to the notion that cycles get worse as you go. ”

        As I said earlier, go with your experience.

        If you are experiencing improvements on meds, stick with them.
        But keep in mind, the more meds you’re on (including self-scripts) the harder it will be to sort the effects of each drug from each other and the underlying condition they supposedly treat.

        If the ‘notion’ that cycles get worse as you go is coming from experience, good. Go with your experience.

        If its coming from scare stories from your p-docs or fellow patients, ditch it.

        There is convincing evidence for a ‘kindling’ effect in untreated epilepsy. The more seizures you have the worse and more frequent they become.

        For the past 20 years, drug companies have been flogging a ‘kindling’ theory’ for psychotic illness too. And an increasing number of quacks subscribe to it. But repeated studies have failed to show even the slightest evidence for it.

        Psychotic illness, including bipolar, tends to develop in late adolescence (the US trend for childhood bipolar diagnosis notwithstanding) peaks in the early 20s, subsides until middle age, gets worse again in late 40s-mid 50s then slowly improves for the remainder of your life.

        Bipolar is not a degenerative condition.

  • deanna

    You are very brave to talk about your diagnosis. I just started a blog on here, and haven’t gotten up enough nerve to talk about it or make my blog public.

    • gmercier4388

      It’s taken me a long time to get to the place I am today, where I’m ok talking about my diagnosis and mental health problems publicly. It sounds like you’ve taken the first steps! I’ve found that blogging has been very therapeutic for me. Just taking the time to write down my feelings or catalogue and make sense of the things that have happened in my life has been a great outlet and has helped me understand how the different events have, as a cohesive whole, led me to where I am today.

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