On Again, Off Again, and Other Bad Ideas (Originally published 11/3/12)

“But it’s a sad man my friend who’s livin’ in his own skin
And can’t stand the company”
–Bruce Springsteen, “Better Days”

When I was first diagnosed as bipolar, I wound up on a combination of medications. I started on Lamictal, which is usually used as an anti-seizure medication. I’d like to say that Lamictal was the answer; that all my problems were solved and it stopped my mood swings. I’d like to, but I can’t. Lamictal may have lessened the mania, but my depression worsened and I began to consider suicide. As I was researching the meds I was put on at various times, I learned that Lamictal had the opposite effect on me than what was expected. For most with bipolar II, Lamictal eases the depression but does little for the mania. Even when put in a group where mental illness was the norm, I was the opposite. I was the craziest even among the crazy. Despite dealing with depression on a fairly regular basis, suicide was the line the sand. Here I was, taking my meds like a good little crazy person, but yet my depression was leading me into the darkest places of my psyche.
This was not the first time I had thought of suicide. I had even attempted it once in high school, but at best, it was a half-hearted try. This time, I had a difficult time thinking of anything else. At the time I was in therapy, seeing both a social worker for the actual therapy, and a nurse practitioner to manage my medication. I told my therapist of my runaway suicidal thoughts. They added a small daily dose of Abilify to the still-increasing dosage of Lamictal. Finally, as I reached the therapeutic dose of Lamictal, my new friend Abilify also kicked in and I finally began to feel normal. Or so I thought.
I was telling everyone that I felt great. “I feel like myself,” was my mantra. That was the problem. I felt like I used to feel, and therefore I could go back to my life. Drugs and therapy were for sick people and I felt great! After four months of drugs and therapy, and I was feeling so good, I stopped going to therapy. A month later, since I wasn’t going to therapy, I couldn’t get refills of my meds, so I just stopped taking them. It all makes perfect sense – to a crazy person.
The inevitable crash was spectacular. It took about two months from mid-July until mid-September before things got dark, but when they did, there wasn’t any beacon of light that could help me. It was a perfect storm. The stressors in my life were all there: I was still separated from my wife and son, in deep financial trouble, had the same ever-present physical ailments; but wait, there was a bonus this time! I started breaking out in a rash on my arms which slowly spread to my back, sides, and legs, eventually covering 70% of my body. The rash turned out to be psoriasis, which can be brought on by…any guesses?…STRESS! I had stress. Imagine that. I started missing days at work again, one or two days then turned into a few in a row which became a problem when I would have to produce a doctor’s note. Through all of this the nice sharp set of knives my wife had left behind, along with a couple of razor blades stashed from my coke days all started to look very attractive.
When I began picturing the aftermath of slitting my wrists, I knew I had to get help and really quickly. I wasn’t going to survive this. The only thing that stopped me was my therapist at one point telling me children of suicides are more likely to kill themselves. I couldn’t leave my son vulnerable to thoughts like mine. This was one thing I never wanted to pass on to him. Thoughts of him growing up and being happy kept me alive.
I went to the nurse practitioner. I was so overcome by the depression that I walked into her office shaking and twitching like a junkie. I barely got out the sentence, “I went off my meds,” and I broke down weeping. Every shitty feeling of the previous two and a half months just shoved its way out. My only concern was still getting a doctor’s note to go back to work. Her response was simply, “You can’t go to work like this.” She was right. It was obvious, even to me, that I had to do something. She suggested the partial program at Four Winds. This was the Thursday before Columbus Day weekend. She asked me if I would be safe by myself over the weekend. I thought long and hard about that. I decided that I would give the partial program a try and told her I would be fine. Besides, I could always kill myself afterward. The Tuesday after Columbus Day I was sitting in Four Winds doing my intake and convincing my new therapist that I didn’t need to go to an inpatient program.

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