Jan 11, 2001

Saw the prescribing internist... my therapist likes him, though I found his approach somewhat cold, but then I was duly warned. He gave me a 4-week supply of Celexa, an SSRI that's relatively recently approved in the US, but has fairly extensive data from Europe. For various reasons, Rob (my therapist) felt that Celexa was the SSRI he would recommend for my particular constellation of symptoms, in particular, my tendencies towards fairly obsessive thought patterns.

Took the 1st dose in the afternoon, around 4:00pm. Diarrhea hit within about 2-3 hours. Feeling hypersensitive, hyperaware of physical sensations.

Jan 12, 2001

Did not sleep well. Rested, but kept waking all through the night. Woke at 1:30 am thinking it must be 4:30. Arghh! Began to notice (is this placebo or is it real?) that I'm doing better at stopping the obsessively depressive cycles of thought that have been with me almost constantly, but have been cycling even deeper since we stopped the EMDR about childhood abuse issues. Diarrhea and jaw tightness continues, though maybe improving.

Jan 13, 2001

Another almost sleepless night. Intense nipple sensitivity, pleasurable in a way but very distracting and didn't help with sleeping. Diarrhea and jaw tightness continued.

Much more forgiving, better able to put things into perspective and enjoy what there is to enjoy.

Jan 14, 2001

Finally a night of more or less normal sleep.

Mood improved, am noticing that I am getting less wary of people in general... easier to smile. This is an observation over the past several days. Still wonder at placebo effect, though Rob (therapist) did suggest that I might notice positive changes after about 48 hours.

Jan 15, 2001

Another decent night's sleep, though this hypersensitivity is something else, still. Sleeping better perhaps just because I'm getting used to it? Trying to find a way to put these effects into clearer language. More initiative, beginning to see that maybe things are manageable, even if they are far from the way I would ideally want them to be. Concerns to raise with Rob: if this is supposed to be a short-term intervention, how do I manage to hold onto the positives here, once we taper off?

Jan 17, 2001

Session with Rob. Says that just about everything I'm feeling is stuff that's been reported. Feeling down more than in the first few days, probably because of a new cold sore outbreak that is doing interesting things to my lymph nodes and general energy level.

Jan 18, 2001

Cold sore saga continues. All I want to do is sleep (which was not a depressive response before. Spinning more than usual, and processing the Wednesday session with Rob is as (or a little bit more) dysfunctionally than usual... most of this must be the exhaustion from lymphatic stuff, and virus, though.

Talked with Deb (a friend) who reaffirmed how exhausting my daughters can sometimes be, and wonder again is he really hearing me? Are his expectations, assumptions and perceptions of me at all accurate? (No. Of course they're not, but I have to be more assertive in letting him know what is going on, to not fall into his preconceptions over and over, and that takes more time and energy than I sometimes feel I have to spare for him and this process...)

Rob mentioned that a lot of the side effects that are common seem to relate to shifts (he did not want to call it weakening) in the immune response. Maybe sensitivity includes a greater tendency to respond to effects of infection and viral stuff??? He says this should pass, but also to say something if my appetite remains seriously supressed.

Luckily, S. was around today, so I was able to nap a good bit of the afternoon. That's not going to be possible next week, so this had better start getting a little better from here on out, or the downside is going to outweigh the upside.

Jan 26, 2001

Catching up. Started to spiral down on Friday, the 19th. Incidents on Saturday triggered a major spinning and obsessive downward cycle that lasted well into Monday, when I left a message with Rob, wondering whether we should increase the dosage. He got back to me late in the afternoon and said, "Yes. It sounds like we should. I can hear you spinning. Call Simon (the internist) just to confirm (and get 'script for further supply) and get back to me." (The initial dosage was 20mg, once a day. Simon had given me 28 20mg tablets in 4 sample packs to start with.)

After getting off the phone with Rob, took an additional 20mg tablet. Past office hours, so I called Simon's office the next morning to confirm the plan. No problem on that end. Picked up the prescription the next day (About 30? 40mg tablets) on my way from daughter's pre-school to my regular Wednesday session with Rob. Describing the resurging side effects and my known sensitivity to these sorts of things, Rob confirmed it would be a good idea to continue taking 20mg tablets twice daily, rather than move immediately to a one-a-day 40mg dose, to ease in as much as possible.

Side effects really scaled up Thursday evening into this morning, with a nearly sleepless night due in large part to extreme skin sensitivity. Am thinking that I should shave (legs, especially) again and keep very smooth, as any hint of friction seems to be setting me off, especially on my legs. Chances are, though, this too will pass within a day or so.

Jan 27, 2001

Couldn't sleep last night more than an hour or two at a stretch. Woke at 2am, filled the bath with bubbles, soaked and shaved. Felt much better, but still very sensitive, continuing into today. The chin tremor was also fairly strong in the morning and off and on through the day. Still getting a prickling sensation on legs and arms, but at least my legs are very smooth. If this keeps up too much longer, will need to shave daily, but I'm guessing that once we've worked into the full 40mg dose it will let up again, as it did after a few days at full load at 20mg

I'm transitioning to the 40mg single dose by moving the 2nd 20mg dose of the day earlier by increments (6pm to 3pm to 1pm to 10 or 11am?) so that by the time the last of the 20mg tabs are gone, it will be as if I were taking two at once. Today's dose was at 1pm, with 3 20mg tablets left, so Monday will be the first day at full intensity. Expect a decrease in the initial side effects by Wednesday?

I'm so glad that I'm dealing with someone who is aware of the real range of side effects, rather than someone who just knows what's on the package insert.

Jan 30, 2001

The last two nights (Sunday and Monday) have shown a return to more normal sleep patterns. A little dragged out, but what do you expect after two days of sleep deprivation and extreme edginess. I've still been edgy, and remain concerned about taking any sort of drastic actions now. Feeling more able to be myself without the alarm bells going off, but not sure I'm not provoking responses here. Have been better about meeting people's gaze (at least from other women... I still tend to avoid men's eyes most of the time, smiling briefly and averting my gaze to avoid whatever it is that scares me about them). Was able to have some pleasant, more open conversations with other moms at R's preschool too on Monday. B woke with a fever, so this is a lazy stay-at-home day for us, reading, doing puzzles, trying to get myself together to begin digging out from all that has accumulated over my depressed periods. Reminding myself to take things one at a time and not allow the seeming enormity to overwhelm. So much will really depend on just getting boxes (and trash bags) and sifting out the clutter.

Still a little anxious that this is how I felt in the day or so after I'd begun to adjust to the lower dose, and then I simply crashed. So much remains unresolved and not easy to resolve at this point. What I really want, and what I've been willing to say I want to Rob, to my partner, to others in my life... such a distance, my trying to minimize the discomfort of others, consistently putting my own needs and wants a distant seventh or eighth priority.

Remembering to stay in the present and not let some (for now) hypothetical future overwhelm me.

Friday, Feb 2, 2001

Seeming still stable. Tempted to describe the sexual side effects of this drug, but since mine seem far from typical, judging from what Rob says, that would seem beside the point, at least for a public node.

While things seem level since my session with Rob on Tuesday evening, I'm still on edge about his thought that we might need to boost the dosage even more. Trying to get a sense of what the criteria would be, since part of me feels like I would want to boost the dose for reasons that may not relate directly to the purely mental effects. Namely, that I rather like some of the physical, sensory side effects, they make me feel more my ideal self than anything I've ever known before, and cut back on some aspects of what I've tended to assume were hormonal imbalances that I would just as soon not have to cope with.

An appointment with the internist on Monday will allow me to check in with someone on this, though I'm hesitant to go into the gruesome details with an internist who Rob reminds me was recommended for his medical competence, not his bedside manner.

I get enough bedside manner from my partner.

Damn, can I be a bitch sometimes or what?

Sunday, Feb 4, 2001

Somewhat "spinny" for the last few days, beginning Friday. A real mess on Saturday night at the bar mitzvah for one of S.'s partners' sons. S. had made some triggering comments earlier in the day, and just generally exhausted from a week of unrelenting childcare. B. had an ear infection from Tuesday through the present, with the fever only beginning to disappear on Friday. R. (B's younger sister) had no pre-school on Wednesday or Friday. The only time I left the house, aside from getting the mail, was to grocery shop late Saturday morning.

The question is, do I need a higher dosage yet, as Rob suggested might be necessary? Or are these stressors ones that would tend to lead to my present level of distress and stress under any circumstances?

S.'s parents visited today. I managed to have a conversation with S's mother at one point early in the visit to let her know what is going on with therapy and the Celexa in particular. In a sense that conversation was a bit of a breakthrough, in that it's the first time I've felt I could trust her enough (and trust my own response) to open up about the process. My sensitivity to her own issues (fibromyalgia and what I read as chronic, unmanaged but relatively mild depression) have tended to leave me uncertain about "burdening" her -- or many others -- with much of the story of my long history of trauma and abuse. So much of my reticence tempered by the expectation that I would be told that my memories didn't in fact exist, or must be fantasy, or other forms of denial and shutting out that I've just not wanted to have to face, if they happened to come along, and so much of that linked into the trauma that Rob and I had started to do EMDR around a number of months ago.

Have been reading Francine Shapiro's guidebook on EMDR, and have a number of questions for Rob. Particularly surrounding "Client Safety Factors" since that seems to be a big one for me, and I still have that level of mistrust and fear, especially when I start to describe aspects related to body image and my emotional responses to "men" in the generic sense. Need to mention my original reservations about beginning therapy with him at the outset.

(Further details in private journals).

Tuesday, Feb. 6, 2001

Noticing continued lethargy at times during the day. The chin trembling also continues, though perhaps it's as much the cold as the Celexa. Had appointment with Dr. M yesterday (internist) and reviewed progress and side effects. He asked me to describe my improvement (or not) on a scale and I asked him to define what he meant.

I probably exaggerated slightly in saying, "Well, if I was at 5% of optimum before starting, and now I'm at 15% then that's a 200% improvement, isn't it?" but somehow that seems close to what I'm feeling lately. Still resentful, petulant and not a happy camper, but able to maintain more clarity about it, at least.

Sex drive has fallen to just about nada, which is (frankly) a bit of a relief, given how much I've felt manipulated around that. Not sure S. would agree with this, but given the comments S. has made about "discomfort" with me and all, I'd just as soon not be feeling that pressure to "put out" and to satisfy S.'s fantasies when my desires and comfort don't seem to matter very much to S.

Yes, I am pretty disappointed.

Did I expect this? Yes. I hoped for more, but considering history, I can't say I'm surprised that S. doesn't really want to touch me when I'm actually honestly expressing how I feel and what I want, rather than playing to S's ego and my intuitive sense of what S. desires from a partner.

After all, I entered this relationship far more for protection than for the sexual chemistry. So why should I be surprised that the relationship has gradually reduced itself to that, as I've grown less and less desperate to give S. what S. wants and ignore my own wants, desires in favor of what felt like desperate, pathetic need? Not being quite as terrified as usual, the glue is beginning to weaken. (Or maybe I was just getting to a point where I felt I that "Well, S hasn't left me through all of this distressing and frustrating drama queen shit, so why should I be so fearful that S is likely to abandon me? Maybe I should really trust after all these years that S loves me (even if S doesn't always express it in terms I find especially consistent with my own sources of sensuous pleasure and whatever... then again, how often do I really ask for what I want? {additions 3.4.01}

Monday, Feb. 12, 2001

Finally recovering from flu. Sequence: first symptoms on Weds., Feb 7, with the real force hitting me on Friday. S. worked weekend, but managed to help line up friends to watch the girls on Saturday while I slept. Sunday, trekked to the pediatrician to check out R. who also had fever starting Friday evening. I am now fairly mobile, but have a nasty earache, probably from all the sinus nastiness that went along with the fevers and chills.

Codes: (D)7-8 (S)5-6? Hard to assign numbers for this period, given that I was sleeping (or trying to sleep) for an incredible part of that time... some improvement, as least on spinning, since symptoms let up.

To be added:

Triggering of mania, provoked by a prescription decongestant and numerous other triggers. Borderline psychosis of extremely brief duration, thank Goddess, but incredibly intense, leading to 11 days of hospitalization, observation and stabilization on new drugs, chiefly Depakote and Seroquel, used to treat a new diagnosis of bipolar disorder.

I find myself in an incredibly new situation now. I have far less social anxiety for instance. Before this incident, it could take me as much as 15 minutes or even an hour to get up the courage to make a phone call. The prospect that I might not get directly through to someone else would itself provoke anxiety... a very bad place to be, and now it seems as though it was never there. I find myself smiling spontaneously at strangers, far less afraid that they might respond to me negatively, far more able to use all the advice I'd gotten in many sessions dealing with a cognitive approach to depression, that focused on getting me out of my shell, with me feeling my therapist was just banging on what seemed like the only protective cover I had.

It's such a different place to be, though in the first few days coming out of mania it does seem clear that I was a little more willing to volunteer all sorts of personal details that many folks are reticent to discuss. Then again, I'm a writer and tend to model myself on others like Doris Lessing, Anne Sexton, Denise Levertov, Sylvia Plath and Emily Dickenson, whose work exists largely in "confessional mode" or at least appears to do so.

Week of Feb. 11, 2001

Recovery from flu, beginning of ear infection. Mania started on 2/13. Led to voluntary commitment on 2/15, in the throes of a pretty vast manic episode of major religious proportions. Woke on structured unit on 2/16.

Week of Feb. 18, 2001

Week spent in hospital. Main meds were Depakote and Seroquel. Fairly manic or hypomanic for most of this week, though managed to make it to the open unit by Saturday (2/24).

Week of Feb. 25, 2001

Getting ready for discharge. Managed to get discharged on 2/27. Still fairly hypomanic, and psychiatrist reduced the dosage of Seroquel because of hyper-grogginess, staggering and physical unsteadiness. This meant, though, that coming home I was still hypomanic to a degree that distressed some others.

Week of Mar. 4, 2001

Adjusting to being home. Mood still fairly high, no longer significantly manic.

Week of Mar. 11, 2001

Beginning to feel medicated into oblivion, though maybe it's also just the exhaustion of trying to make up for lost time, and the pressures that are inevitable whenever my parents (especially my father) are around.

Week of Mar. 18, 2001

Mild improvement of mood, but still feeling very drugged. Parents have left, so after about 3 weeks at home I have (a little) time to myself, not serving others' needs and wants.

Weeks from late March to April 12, 2001

Mood slump extraordinaire. Probably due mainly to the continued dosage of Seroquel. After returning from Disney World at the end of March, we began to taper off the Seroquel but the dosage remains too high. We also began to switch over from Depakote to Lithium (or Lithobid). As someone put this the other day, we're in neuro-receptor hell. An incredible stew of stuff playing pinball with every mood-altering receptor known to psychochemistry.

UPDATE - November 16, 2004 - UPDATE

Lithium was not something that I tolerated well. After several months of cramps and comfort eating, in which I ballooned from the 170 lbs. I had been at the start of my hospital stay, within less than a year, if memory serves, I had gained to weigh an utterly gross 230 lbs. Weight has continued to creep upwards, to about 250 by now, but the pace slowed considerably once I began an alternate treatment regimen of Wellbutrin and Depakote.

Overall, my mood has gradually stabilized to a more functional level. Self-esteem issues continue to grate, as these events proved intolerable to my spouse, who pushed through a divorce that was formalized at the beginning of March, 2003. I still ask myself why I continue to use the therapist who originally screwed up the diagnosis, and I suppose at least some part of it has to do with my sense that he feels a greater debt of attention and focus now than he did before, and that finding a new therapist would merely be trading one imperfect functionary for another. Since it's essential to my continued progress that we monitor and look for the signs of mania or depression that are particular to me as an individual, I may as well work with the "helper" who knows the history better than anyone, save myself, of course.