Quick Update: Titration Is Hell

Recently, my sister told the story of when my brother-in-law ran the 2012 Boston Marathon. The night before the race I made homemade pasta with my nieces and the next day — an unseasonable scorcher for Boston in April — I managed to drive to the finish line to shuttle him out of the city with the AC blasting and the car loaded with water, Gatorade, chips and all the other things runners crave after a marathon.

It was a nice memory, but it might as well have happened to someone else. I welled up at my inability to recall those moments and worried about what other moments I’ve lost over the past few months and years.

It could be a product of my age or the heroic quantities of cannabis I used to self-medicate the past few years before my January hospital stay got me on a more appropriate — and effective — medication protocol. But memory loss is also listed as a side effect on a couple of the drugs I take to control my bipolar disorder and depression, so it doesn’t seem coincidental that it’s been escalating this year.

My memory loss is likely a product of all three of those things. But there are other side effects that are clearly linked to my meds. After losing 70 pounds over two years, I’ve gained back 20 since January thanks to Abilify. Because I’m still working on finding the proper titration of my meds, my anxiety has been nearly crippling — a side effect which, so far, has only been partially offset by antianxiety meds and techniques I learned at McLean.

The long lag between this and my last entry on FWB is an indirect side effect: I have trouble concentrating, and the drafts I’ve started have been cut short when I decided they weren’t up to my standards¹. I’ve also learned a new word - anhedonia, or lack of pleasure in activities that normally bring pleasure. That may or may not be a side effect of my medication — it’s also a common symptom of depression and bipolar disorder — but it’s only cropped up in the past couple of months, which makes me worry it’s tied to the meds that are otherwise doing what they’re supposed to. What I do know is my cigars don’t taste right, I don’t enjoy reading the way I used to, and I’m less engaged with work. Music, which I used to get lost in, is now usually background noise at best. Food tastes different, and I’ve gone to three straight comedy shows where I’ve struggled to crack a smile.

(Fortunately, anhedonia comes and goes — it’s not a constant state — and has not had any impact on the pleasure I get from spending time with my family and friends).

Here’s the good news: I have not had a major manic or hypomanic episode since being discharged in January, and I’ve been able to stop almost all the minor ones using the techniques I learned at McLean. That alone has been enough to keep me from getting discouraged.

Because when you get discouraged, when you let the side effects win, you get fed up and say “to hell with the meds.” It’s a cliché in television and movies for bipolar characters to “go off their meds,” but the problem with clichés is they’re so deeply rooted in truth. My therapist warns on a weekly basis that almost everyone with BPD contemplates going off their meds at some point, and far too many do indeed make that dreadful decision.

I’m not there yet — not even close, because I’d rather be miserable without manic episodes than miserable with manic episodes. I’m still putting in the work with my prescriber, working through the trial-and-error of finding the right combo of meds, therapy, and self-care. Weekly therapy and weekly support group are still my norm. I’m doing the work and reminding myself in another few weeks, or another few months, I’ll likely feel a lot better than I do now.

It’s not easy, but it’s necessary. And I’m not sharing this rather raw piece because I need sympathy — I’m not great right now, but I’m okay, and I’m safe. Like most everything I do on here, it’s aimed at (hopefully) helping people with mental health disorders feel a little less alone and helping the people who love us gain some insight into what we deal with on a daily basis.

1. This one is barely passing muster, but I feel I need to click “publish” and stop letting perfect be the enemy of good.