ketamine – Mirrored Madness: The Monster In Me

All These Medications

“It’s difficult. I take a low dose of lithium nightly. I take an antidepressant for my fatness because prayer isn’t enough. My therapist hears confession twice a month, my shrink delivers the host, and I can stand in the woods and see the world spark.”
– David Lovelace, Scattershot: My Bipolar Family

If you haven’t read Madness by Marya Hornbacher, I highly recommend that you do so. Especially if you suffer from bipolar disorder. She’s not Stephen King, but the book is as equally terrifying as anything he has written.

As someone who does suffer from the illness, I look at the book, which is a devastatingly honest memoir, as a shield. It’s far from comforting, but it is a book that captures Hornbacher’s long and torturous journey.

There is a section at the end of the book about different facts about the disorder. Many I knew. Others could be terrifying footnotes to an already terrifying book. Hornbacher even lists her medication regimen in the section. I noticed we shared a few medications and it got me thinking.

About all these medications.

Over the course of seven years, I have been on countless medications, which I am currently paying for. I have always been consistent in taking my pills. I have never gone off my meds. I have never had any reason to. But I’m beginning to wonder if the damage done by years of taking numerous medications is just as bad as not have taken them at all.

I know, I know. That’s dramatic, but still. Pills that were supposed to help my brain function are now having if not an opposite effect, a disappointing and new one. I’m not experiencing the basic “blah” one might feel on antidepressants. I’m experiencing total loss. Of conversation. Of thought. My doctor is even wanting to wean me off some of my necessary meds because of some of the issues I am having. It’s just not possible.

There are so many different medications for bipolar disorder. It’s insane. I know everyone is different, but why not try and fix a medication that “doesn’t work” or has “flaws” instead of creating a new one with new problems?

Big Pharma, baby.

There is no cure or direct known cause of bipolar disorder so it’s impossible to create a universal drug to treat the illness. However, there must be a more stable medication or clinical treatment.

And they say that’s Lithium. The problem? The same: the doctors throw a handful of other pills on top that.

Multiple medications are necessary in the treatment of bipolar disorder, but not all the ones that are typically prescribed.

On average, it takes someone with bipolar disorder 10 years to receive the proper diagnosis. That’s a lot of different pills, my friend.

If it it’s a 10-year journey, I’m three years out and am still keeping my fingers crossed.

Memories and Nightmares

yellow stethoscope and medicines on pink background

“Swinging by some shoelaces and weathered chains, my atoms rearranged, rearranged.”
– Tummyache, Median

Memories. I know this is something I have touched on several times in my 60+ posts over the last three months, but I can’t get away from it or all of the memories surrounding it.

This month marks the 20^th anniversary of the suicide of a close friend. He hung himself in a tree in his backyard when I was in the 6^th grade. We just so happened to be neighbors, so I was there and saw the whole thing.

I know the suicide of a loved one can affect people differently – many go through different phases or stages of grief, anger, understanding, acceptance. Not me. I never cried and I was never mad or angry, just in total shock. Disbelief. Numb isn’t the right word, either, but it felt like a punch to the gut I would never recover from. The memories of it all still and will forever haunt me.

Untreated mental illness is dangerous, and my friend Mark was a prime example of that. The statistics are alarming, but there are those who feel the statistics are meant to alarm. But I can’t seem to shake it. Without sounding “oh, woe is me”, it just shouldn’t be the case.

I was first diagnosed with bipolar disorder at age 15, again at 17, and then at 24, which is when I decided to seek out treatment. If I hadn’t I more than likely would’ve been just another statistic.

And instead of me regurgitating a bunch of facts, I’m just going to go straight to the horse’s mouth instead of spouting out memories of facts:

How common is bipolar disorder?

Globally, 46 million people around the world have bipolar disorder. (Our World in Data, 2018)
One survey of 11 countries found the lifetime prevalence of bipolar disorder was 2.4%. The U.S. had a 1% prevalence of bipolar type I, which was notably higher than many other countries in this survey. (Therapeutic Advances in Psychopharmacology, 2018)
Annually, an estimated 2.8% of U.S. adults have a bipolar disorder diagnosis (Harvard Medical School, 2007).
Of all mood disorders, those with a diagnosis of bipolar disorder were found to have the highest likelihood of being classified with “severe” impairment (82.9%). (Archives of General Psychiatry, 2005)
The past-year prevalence of bipolar disorder is similar in females and males (2.8% and 2.9%, respectively). (National Institute of Mental Health, 2017)

Bipolar disorder statistics by age

The average age of onset is 25 years old. (National Alliance on Mental Illness, 2017)
People ages 18 to 29 years old had the highest rates of bipolar disorder (4.7%) followed by 30- to 44-year-olds (3.5%) as of 2001-2003. (Harvard Medical School, 2007)
People 60 and older had the lowest rates of bipolar disorder (0.7%) as of 2001-2003. (Harvard Medical School, 2007)
Only 2.9% of adolescents had bipolar disorder as of 2001-2004, the majority of which had severe impairment. (Archives of General Psychiatry, 2005)

Bipolar disorder and overall health

On average, bipolar disorder results in 9.2 years reduction in expected life span (National Institute of Mental Health, 2017).
The risk of suicide is high in people with bipolar disorder with 15% to 17% committing suicide. (Treatment Advocacy Center)
Up to 60% of people with any mental health disorder, including bipolar disorder, develop substance use disorders. (WebMD, 2006)
Of those with bipolar disorder, many report co-occurring health conditions, which are most commonly migraine, asthma, and high cholesterol. High blood pressure, thyroid disease, and osteoarthritis were also identified as high probability co-occurring health problems. (The British Journal of Psychiatry, 2014)

This particular stat suggests that up to 20% of bipolar subjects end their life by suicide, and 20–60% of them attempt suicide at least once in their lifetime.

That sentence should scare the shit out of you. It should be cause for alarm. And it should be a wake-up call for those who judge or are ignorant to this illness.

Less than 3% of the United States population suffers from this disorder. We are by far outnumbered (not that I would wish this affliction on anyone) and it’s sad. Mental illness and mental health awareness in general has improved in this country to an extent, but nowhere near enough to make much of a difference.

I find it interesting that because I am bipolar, I have a decreased life expectancy of 9-17 years. Because of the possibility I may kill myself? Because of the dangers of mania? Why exactly?

Cognitively, I am slowly declining. That’s why reading and writing are so important to me. I want my mind and my memories. I always want to remember. I never want to forget

Self-care is super important, and fortunately I still manage in that department. I could exercise more and eat healthier. But other than that, and staying on a good medication regimen, what else can I do to maintain? And when that only helps to a certain point, what do I do then?

I manage, I guess. I may not do it well, but I never back down. But how long can that pretentious mentality last? Do you think the 20% of people with bipolar disorder who committed suicide were always suicidal? What about the 60% that attempt it?

This isn’t a cry for help, but a call to arms. March 30 was World Bipolar Day and I’m not sure how constructive that was, but it didn’t affect me one bit. No one called me or asked for my opinion. I didn’t receive any notice or information. I think it was just a day for fellow-bipolars to get together and be happy and spread “awareness” – amongst themselves, that is.

But I’m not happy because no one is truly aware. Not to the point that it makes much difference.

But when more than 50% of a certain population will attempt suicide and people are still hiding from that reality, continuing to stand behind the stigma that is so hazardous to those with a mental illness, bipolar disorder in particular.

Hopelessness. That’s the one emotion someone with any mental illness needs to avoid. In my opinion, many reach that hopeless state because of the stigma and lack of help available.

I am not suicidal and am in no way judging anyone who is. I’m just here to let you know that someone is on your side. I’m here and I’m pissed. This isn’t my battle to fight alone, but I’m tired of feeling alone so it’s time to stand up for change. If no one else will, we must do it on our own. If we do not take this disorder and all of its idiosyncrasies seriously (and not just us bipolars), we are looking down a dark, downward spiral of chaos.

I may be biased because I saw my friend with an untreated mental illness hang himself 20 years ago this month. I may be biased because I am bipolar, and I know the ins and outs.

It’s time for a change, though.

I’m tired of statistics, and I refuse to be one.

Books That Have Shaped Me

“Books are the quietest and most constant of friends; they are the most accessible and wisest of counsellors, and the most patient of teachers.”

– Charles W. Eliot

Well, after the week I’ve had I thought I might do something a little more light-hearted. I’ve already discussed the power of music and the artists and albums that shaped a great part of who I am. So, I thought I might talk about some of the books that have also molded me into the person I am today.

I’m pretty eclectic, enjoying Steinbeck as much as Stephen King. I could go on and on about authors and pick them apart, so I’m going to stick with specific books (I’m still trying to conquer Infinite Jest, so…yeah).

The first book that had a profound effect on me was Crime and Punishment by Dostoevsky in the 7^th grade. I was, in a way, shunned by the school librarian, almost looked down upon as if I were some sort of creep or sicko (the school only went up to the 8^th grade so who could check out that book without facing some sort of scrutiny?). It’s a great book and laid out and told in a unique fashion, of course, but I’m pretty sure it was the being looked at as “weird” or, most likely, feeling out of my depth that affected me the most.

Then I discovered Stephen King, and after reading Pet Sematary I knew Dean Koontz was nothing but a footnote in the world of modern fiction, an author that my father for some reason professed as being one of the best. I respectfully disagree.

When I was 13, Pet Sematary was the first book I bought with my first mowing money (that and Dreamcatcher which was not one of my better decisions). Even as a young kid I was a horror fanatic, but Pet Sematary really scared me. The movie, as well. It’s a hard story not be affected by.

I was then on a Stephen King kick and got lucky in that the next two of his books I read was The Stand and It, both of which are amazing stories as King knows how to develop a slew of memorable characters in a way that their personal development is more entertaining than the plot. My King kick continued, and although there are many duds, I own every single one of them.

When one speaks of Kerouac, On the Road is the first three words you will always hear. And although it is a great book and a perfect introduction to the work that was to come, it was Big Sur, Desolation Angels, and The Dharma Bums (“When you get to the top, just keep climbing!”) that cemented my belief as a writer that “first thought-best thought” was the way to go…that is until I re-read some of my writing and soon realized I was no Kerouac.

Howl by Allen Ginsberg, actually a long-form poem, opened up my eyes just as much as any book. The first time I read the poem, I became instantly aware of a new style of writing that changed the landscape of 20^th century poetry and beyond. The raw, yet technical beauty of the words is jaw-dropping. I decided immediately that Frost nor Dickinson had nothing on this guy.

The Razor’s Edge by Somerset Maugham will always be on the list (it was the first book I read “under the influence”). I just love the story, even when I’m sober. I highly recommend it.

I, of course, grew up with the Harry Potter series so sue me, they’re great books, Plus, they got millions of kids who would otherwise not even touch a book excited about reading. And who can deny that power? But it didn’t take long for Tolkien to make his entrance into my life, easily knocking Rowling down a few rungs. It’s a toss-up at times; ask me today and I’ll say Tolkien, ask me tomorrow and who knows what I might say.

But back to Infinite Jest…my first question: is David Foster Wallace crazy? Such a mammoth of a novel, and with 300 pages of footnotes to boot! To answer the question, though, no, he’s not crazy. His brain just worked in amazing ways. If you’re interested in checking out Wallace’s work, I would recommend starting out with A Supposedly Fun Thing I’ll Never Do Again or Consider the Lobster. One day I will finish Infinte Jest, and then I just may retire from reading altogether. Go out with a bang (kidding, kidding)! Ol’ Stephen King said that if you do not have the time to read you will never have the tools to be able to write. Pretty astute, yet common sense, if you think about it.

I could go on, and I know I’m missing many books that I could include, some even in my “Top 10”. But I don’t review books for a living, nor are any of these recommendations. These are books (and different styles of writing) that have shaped me and have a place in my heart, almost like little literary milestones. These aren’t just favorites, they’re the books that triggered growth in me as a person and a writer (no, I’ll never attempt to sit down and rewrite On the Road, but the impact it had on my life is there).

Books, just like music or whatever else it may be, are an escape for me, as they are for many. They are eye-opening in the sense that it’s clear that creativity and dedication really do pay off. You may not write the next Infinite Jest, but dedication and a little magic can go a long way.

MY TOP 5 LIFE CHANGING BOOKS (in no particular order)

East of Eden – Steinbeck
It – King
Big Sur – Kerouac
Madness (memoir) – Hornbacher
Brave New World – Huxley

What are some of the books that have shaped who you are and how you approach your writing?

A Slight Return to the Madness

“Soon madness has worn you down. It’s easier to do what says than argue. In this way, it takes over your mind. You no longer know where it ends, and you begin. You believe anything it says. You do what it tells you, no matter how extreme or absurd. If it says you’re worthless, you agree. You plead for it to stop. You promise to behave. You are on your knees, and it laughs.”
– Marya Hornbacher

Well, it’s been a week or so since my last post, so this is just me checking in, I guess.

Of course, it’s been one of “those” weeks: work started back up (yards needed to be mowed). On top of that, I spent Wednesday and Thursday in bed, depressed as usual (I wish people knew what it meant to literally not be able to get out of bed).

But in my rapid cycling nature, I am back, and have spent the last couple of days in a state of “stifled mania” (the medication helps the severity of the episodes). Today is Sunday, though, and I’m glad to be able to enjoy the beautiful weather here. And no work. It’s a great day to spend with the family and I’m genuinely happy. It may be fleeting, and tomorrow is a new day. So, who knows, right? All I can do is all I can do.

The above quote is as accurate as it gets. It never goes away, the madness. You eventually realize the demons aren’t laughing with you, but at you. Like every time before, though, damage all but done, it passes like all else.

I’m planning on spending some more time on another writing project, as well, but I’m not going anywhere. I just needed a recharge.

I hope that’s all, anyway.

a day in the life: one day at a time

red flower near white flower during daytime

“There is a crack in everything, that’s how the light gets in.”
– Leonard Cohen

As I write this early Tuesday morning, I can in good faith look back and reflect on how good yesterday was. Not that I can sit here all “woe is me” like I never have good days, but yesterday felt like a fresh start.

First off, work is picking back up as the warmer weather is (maybe) finally starting to settle in. I work for both a lawncare and a construction company. Yards will need to be mowed; houses will need to be built or repaired. Things are about to pick up and get busy. It’ll be mornings of rushing to get the kids shipped out to whoever is watching them on that day by 6 am. It’ll be the “get-up-and-go” this household really needs.

On another note, I had my second ketamine treatment last night and the relief was immediate. No, there was no “high” or “buzz”, as I’m often asked. It takes a few minutes to wake up and come to after the infusion, but there is nothing other than that if you’re someone trying to chase the dragon. I just felt all of the stress go away. I’m less tense and uptight, and I can even handle some of my OCD/superstitions that could laughably be debilitating. But that in and of itself is proof there is something to this ketamine regimen.

I am thankful for my family and am slowly starting to realize to not push them away. I’m learning how personally devastating it is to be bitter and to hold onto those little feelings every day. Let it go. I have an amazing wife and three beautiful sons that need me. And they need me to be me, not the person I have been and will still (unfortunately) become at times.

But even after writing that last sentence I still can find some level positivity in the situation, if only by not dwelling on the issue. That is new for me. My usual moody attitude would’ve normally kicked into full gear, and I would’ve ended up dead or in jail.

It’s nice to be able to reflect in a positive sense, not having to worry about getting fixated on a topic that concerns me in no way. That’s an intense state of mind and I’m happy for the relief. At this point in time, I’ll take whatever I can get.

Just remember when you wake up every morning to find or think of a few positive things right off the bat. Easier said than done, right? But it can be done. I’m doing it as I’m typing these words right now. If I didn’t know better, I would think I’m in the beginning stages of a cycle. Fortunately, I am not on any drugs, and I am lucid and have been for some time now. So that’s a nice feeling, too.

Well, it’s early and it’s about time for work (don’t you know there are yards to be mowed and houses to be built?). I just wanted to check in and remind anyone who needed reminding that, even through the madness, there is light. You may have to look a little bit harder some times, but it’s always there.

Happy Tuesday everyone!

On the Fear of Death, Dying, & Drowning

close up photography of concrete tombstones

“Death is as natural as life. It’s part of the deal we made.”
– Mitch Albom

It’s a subject as old as time, and a personal dilemma everyone experiences at some point in their lives: the fear of death and dying.

It would almost be negligent to let on that I’ve never fixated on the thought of dying and, of course, what’s to come after.

I’m not of the belief in a “Christian God” or a “White Jesus”…but on the same token I’m terrified of going to hell. It doesn’t make any sense, I know. But it’s true.

I’m not scared to die, though. I think I’d die for anybody. I would just want it to be quick, painless (who wouldn’t, right?). Don’t get me wrong. I in no way want to die, but you have to accept dying as a part of life or you’ll get too hung up on it, and that can be dangerous.

I get hung up on a specific fear of dying: drowning. I’m outright terrified of water…yet it never stops me from getting in; I’ve been in pools, ponds, lakes, and two oceans. But the entire time I am I’m in a state of anxiety and fear like no other. I hate water. I’d rather burn alive than spend my last moments in that type of fear accompanied with drowning.

The fear of drowning is called aquaphobia. In fact, aquaphobia is the irrational fear of drowning. I would say, partly because of my “condition”, most of my fears are totally irrational. For instance, I have to have the volume on the TV on an even number. I know it’s insane, but it’s a true fear. I honestly believe your shooting dice with the Devil if you have your TV volume on an odd number. I’m as neurotic as they come.

Fears can either teach or they can torture. They say you have to “face your fears” to conquer them. Most people try to avoid them completely so as to not have to even bother with the thought of it. I mean, how can the fear of death and dying be conquered? At best, it can only be accepted.

The fear of the possibility. That is a true fear I suffer from, and it can be debilitating. The anxiety that comes with just the possibility of something bad is phenomenal, except not in a good way.

The fear of death and dying is definitely a rational fear. It’s the fear of the unknown. The fear of what you have to leave behind. It’s rational, I just “handle” it irrationally.

I’ve decided to avoid the time spent on thinking about death by just never dying. I never want to die so that’s the plan. It may be irrational, but whatever gets me through the night, right?

But am I scared of dying? I don’t WANT to die, of course. but it is a part of life. And I have accepted that.

I agree the idea of not dying may not be a good plan, but it’s all I got (If I didn’t laugh all I would do is cry). We’re all going to die. And I’d like to believe we just drift off into the stratosphere, but as a nihilist, I honestly believe that after we die it’s all just black, an eternal void.

If I’m wrong, I just hope that when I die I make it to hell before the Devil knows I’m dead.

And then there was Ketamine…

“Bipolar robs you of that which is you. It can take from you the very core of your being and replace it with something that is completely opposite of who you truly are.”
– Alyssa Reyans, Letters from a Bipolar Mother

So, I go in for my second ketamine treatment on Monday, and boy, am I relieved!

I did my first round a few months ago and I could tell an immediate difference. But the farther apart each treatment is the less effective it will be. In fact, it’s recommended to do six rounds in three to six weeks. At $450 a pop, however, that was just not realistic at the time.

WHAT IS KETAMINE?

Ketamine got its start in Belgium in the 1960s as an anesthetic for animals. Ketamine has since been FDA-approved as a safer form of anesthesia for people, as it doesn’t slow down breathing or heart rate.

But most notably, ketamine is getting a lot of attention as a more serious, long-term treatment for depression, PTSD, and bipolar disorder. It causes what doctors call a “dissociative experience”.

John Krystal, MD, chief of psychiatry at Yale-New Haven Hospital and Yale School of Medicine in Connecticut, described what this dissociation may feel like.

“Ketamine can produce feelings of unreality; visual and sensory distortions; a distorted feeling about one’s body; temporary unusual thoughts and beliefs; and a euphoria or a buzz.”

However, the drug’s potential as a treatment for depression and antidote to suicidal ideations has piqued the interest of many researchers. It has been studied and administered to people for decades with mostly positive results.

“We’re reaching out in a new way to patients who have not responded to other kinds of treatments and providing, for some of them, the first time that they’ve gotten better from their depression,” Krystal says.

BRINGING IT BACK HOME

After my first ketamine infusion, I felt an immediate sense of relief and release. It was so nice to not even be able to remember what being depressed felt like. But if you don’t get the full recommended treatment plan up front, the effects of the ketamine ultimately wears off. And you’ll know it when it does.

It’s also recommended that talk therapy should commence as soon as the patient “comes to” after the infusion. Ken Stewart, MD, expressed this same sentiment.

“It’s my sense that this is important,” Stewart says. “When people come out of this really profound experience, they have a lot to say, and these are people who have a lot of baggage and a lot of experiential pain. A lot of times, ketamine leads to an unpacking of that baggage.”

My upcoming ketamine appointment couldn’t have been scheduled at a better time. When in the throes of mania or in a bout of depression, reality can be fragmented and frightening.

Bouncing around between mania and depression isn’t easy, and if the ketamine infusions are proven to help then I’m going to do what I need to do to achieve some semblance of normalcy and relief.

Hey, whatever works, right?