The Kick Inside

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  The Valproate Family
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  Lamictal
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  The Talk: The Doctor Will Always Discourage You Ever Getting Pregnant
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  Tammy
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  Shite
• 
  Manic depression is hereditary
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  Crap Poetry Aged 15
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  Sigh

Now, I’m 21 and not planning on getting pregnant anytime soon. Yet, since the day I began treatment, doctors have been protecting my phantom baby. A typical exchange in my psychiatric appointments follows this general structure:

Me, in a whiny voice: “I don’t want to take my Lith-iiiieee-ummmmmm, it makes me feel sick and I have put on tons of weight”. *sad face*

Doctor, in stern, teacherish voice: “If you don’t take your Lithium with your antidepressants then you will have to go to hospital again. And this time for much longer. Months. You will go sky high again”.

Sullen me: “I have already gone sky high even as I was taking Lithium”.

Doctor, exasperated: “Look, Lithium is the safest mood stabiliser for women of your age“.

By “my age” he means of “childbearing age”. Yet apparently Lithium should be avoided during pregnancy as it cause prenatal defects. Which begs the question- just how dangerous are other mood stabilisers to the unborn child?

The Valproate Family

Well, sodium valproate also carries a risk of foetal defects. Read the whole article on valproates, but this in particular is quite sobering:

Of 403 pregnancies in women taking antiepileptic drugs (AEDs), 87.8% resulted in a healthy live birth and 5.2% resulted in a live birth of a child with fetal malformations, ranging from neurologic to genitourinary to skeletal abnormalities. The remaining pregnancies ended in spontaneous abortion or premature death in utero.

The fetal malformation rate was significantly greater in pregnancies exposed to valproate in the first trimester, compared with those exposed to all other AEDs in the first trimester. (16.1% vs. 2.4%). Additionally, the incidence of fetal malformations was significantly higher in women taking valproate than in those taking no AEDs (16.1% vs. 3.1%).

The higher the dosage, the greater the risk according to Diana Mahoney. Reading around, statistics quoted are much the same.

Valproates and Lithium are the two most commonly prescribed true mood stabilisers used to treat Bipolar 1 in the UK.

Lamictal

Bipolar II is often treated using Lamictal. It’s also approved to treat Bipolar 1, but only when stable on other medications. As for Lamictal and pregnancy, there’s little information out there. Best I can find is this from the FDA, which says that babies born during Lamictal treatment are at higher risk of cleft palette.

So, the two “true” mood stabilisers are harmful when pregnant. Information surrounding Lamictal is shady. What can you take during pregnancy, then?

The Talk: The Doctor Will Always Discourage You Ever

Getting Pregnant

I had “The Talk” with my doctor regarding pregnancy. I have always wanted children, loving my little siblings like they were my own, in that freakish big sister way. However, I also have PCOS, meaning my periods come when the damn well want to, which reduces my chance of conceiving and heightens my chance of miscarriage.

When I told my psychiatric doctor this, he was almost relieved. “The Talk” considers the risks of pregnancy to the manic depressive woman.

I’ve been told that if I get pregnant, I can continue Lithium but need to know the risks. Problem is, Lithium is really not that effective for me. It only has a 40% success rate, and Lithium is the first line treatment for mania. So the 60% whose doctors won’t let them switch- where does that leave us?

I’ve also tried Tegretol and Zyprexa, both extremely unsuccessfully. So if I want to reduce the risk to my unborn child (note: not eliminate it), I have to continue taking the ineffective Lithium. Tegretol is also harmful to foetus’.

Another option aside from Lithium is taking an old-school antipsychotic like Haloperidol. Haloperidol is an extremely blunt tool when dealing with complicated mood episodes and carries risks such as tardive dyskinesia. See your neighbourhood schizophrenic who creeps you out because their tongue moves in their mouth like a blind worm? It’s likely they have tardive dyskinesia induced by old school antipsychotics.

Haloperidol and its cousin Thorazine are both pills I have taken and I wouldn’t trust myself on them in pregnancy.

So, that was one part of the talk.

I then got the lowdown on the risks of becoming pregnant. The National Alliance of Mental Illness articulates it pretty starkly:

Because bipolar disorder emerges during young adulthood and persists throughout the lifespan, women of childbearing age are at risk for this illness. Pregnancy and delivery can influence the symptoms of bipolar disorder: pregnant women or new mothers with bipolar disorder have a sevenfold higher risk of hospital admission and a twofold higher risk for a recurrent episode, compared with those who have not recently delivered a child or are not pregnant.

Basically- we might go absolutely nuts.

Tammy

I witnessed this first hand in hospital with a heavily pregnant bipolar woman called Tammy. Tammy was extremely violent and suffering from psychotic delusions. She believed her child was eating her from the inside and would call every day for the nurses to abort it. It was shocking to witness. She was being medicated with Haloperidol and various sedatives and would be quiet every few hours before the halls would rattle with her petrified shrieks.

Shite

Thing is, I have to listen as I know I have a history of psychotic mania and psychotic depression. So it frightens me to know that that most happy of events- carrying a baby- might make me so ill that I could hurt myself or my child.

The doctor was gentle with this information. He’s blunt like that. He wasn’t mean. He was nice but a matter of fact.

I had always feared post-natal depression but I know that in my depressions, save for the bleakest I have experienced, I can always be reached. Some anchor is dropped, some voice is faraway above the well’s mouth, but I can hear it. It’s a whisper, but I can hear it.

Psychosis is not the same. Psychosis is unreachable, unreal, uninhabitable and unimaginable for anyone other than the person locked inside it.

It horrifies me that I might become psychotic while pregnant. That all us manic depressive ladies out there might fear the thing inside them. Or adore it, too much.

If that wasn’t enough to put me off…

Manic depression is hereditary

Mental illness giveth, mental illness taketh away…

While I can see some valuable things I have gained from being a Mentally Interesting Girl diagnosed young-ish, that isn’t something I’d ever want to pass on.

I do have some insight into things I would never have even thought about otherwise. Things like psychosis, mania, depression, suicide and oh, positive things too. Like how people endure and carry on. And how they recognise- by and large- that mental illness sucks, it could be worse. Granted, I only had this sort of self-awareness very recently, but those clear times are quite valuable. My illness is now a part of me. Not the whole of me, but it’s part of my identity because it affects everything at the core of who I am- my moods, my emotions, my energy, my creative abilities.

But, that said, I would never want to pass it on. Manic depression is hereditary. And as well as giving me some insights, it’s taken me on hell-rides, severely truncated what I’m likely to achieve in life and removed a modicum of control from my moods and emotions, on who I could have been.

What we have to ask ourselves then, when we think of getting pregnant or getting someone pregnant- do we want to pass this on?

Crap Poetry Aged 15

When I was 15, I wrote a really shit poem called, “The Heirloom In my Family Is Mental Illness”. Oh woe! I hear you cry. While the rest of the poem was as teenage wankish as you could get, the title did hold truth.

Mental illness runs in my family. There is a vein coursing through us, from my great-grandmother, to her daughter, to my mother, to me. Sadly, it runs thus on the other side too, but that side bred alcoholism, which eventually stole my father from me.

Mental illness can come from nowhere and it can be caused by traumatic life events. But of all the psychiatric illnesses, bipolar disorder seems to have the strongest genetic link.

Sigh
So, I had that merry onslaught chucked at me when my pregnancy questions peeked above the parapet.

Becoming pregnant when you’re manic depressive is tough. It’s not impossible, though. Pregnancy is tough to deal with whatever the circumstances. It’s just that much harder when you suffer from a mental illness. And if we were all afraid of passing on the “faulty gene”, we wouldn’t be here, us Mentally Interesting folks, and that would be a loss.

I’m going to take the advice of Generic Wise Man and wait and see. You never know.

It’s scarcely worth a doo-wop and Do You Smoke?

Greetings from a bed and breakfast in Belfast.  It is very odd yet kind of cool to be in a B and B in my home town.  I guess it says a lot about my relationship with the place.I deleted my last entry as it was far too personal for a blog such as this.  It made me somewhat uncomfortable reading it, nevermind anyone else.  It’s neither your concern nor business if it doesn’t involve the subjects I created this blog for.  Trouble is, subjects such as these are all-encompassing.  The gist was:

Nice to be home, for a change

My relationship with my home town is fraught.  A lot of bad things have happened to me in Belfast, a lot of people are gone now, I had no wish to live with ghosts.  At least since my diagnosis I have understood that I wasn’t a bad person, wasn’t deserving of some of the shit that was thrown at me.So our relationship is more tender now.  I am feeling far more gracious towards the city and its skelatons.  On almost every mission home I have attended wakes, funerals, bedsides, ghosts and this time I am here for no reason.  It’s so lovely.  Last night I sat on the damp steps of a fire escape and looked at the stars.

Yeah, yeah.

Oh, I know you retched at the last sentence but up yours.  Sentimentality is the one thing I didn’t have when looking at the past and now it feels a little more within my grasp.  So to be mawkish and embarassing about it all is happy to me.  I always have such horrible stories to tell.  It is nice to remember the happy ones at last. 

My feet are frozened on hardwood floor.  The room I am in is palacial, it’s ridiculous.  Yet it’s a cheapo B&B for breadliners like ourselves. We stayed here last year when my dad died.  Rob slept while we attended the wake and found a rat in the cupboard.  I daren’t mention this, but when they give me a measly portion of scrambled egg tomorrow morning for breakfast, I might mention it.  Play my trump card and receive an extra slice of toast.

Seroquel strikes again

Seroquel has now ruined two days out of seven for me.  On Saturday it blitzed my chances of becoming a moderately paid extra in a music video and today it obliterated any hope I had of waking up before the sun sneaked behind the clouds.  I did make it for 9am, but then felt absolutely bizarre.  Horrible dissociation (“Are those my hands?” “Is this chair solid?”) and dizziness.  I bravely sucked a shaking cigarette before passing out again until the afternoon. 

Bundle of fun me, I tells you.

A rumination

I am legendarily nosey and have a question. 

As well as often having substance abuse problems, it’s been said that a large number of people suffering from mental illness smoke.

I smoke 20 or so a day. The number of cigarettes I smoke doubled when I was in the mental hospital and now my habit is more severe. I don’t like smoking but am hopelessly addicted and I am also rather furtive with my hands so it keeps them busy.

Do you smoke? Do you ever think about why you do? Whether you suffer from a mental illness or not, vote in the poll and let me know.

I have tried to post a poll here four times but WordPress ain’t having it.  You can vote by clicking this link.  Yes, this link.

Because most of my family smoke, I always assumed it was the done thing. I was shocked when I moved to London. People found it repulsive and socially unacceptable. Not all people, of course, but no-one has ever barked at me to stub it out anywhere else.

Kisses

Today is Valentine’s day so go out and tell that mysterious passerby you love them.  When you find out they’re you’re erotomanic stalker, don’t blame me.

Body Dysmorphic Disorder- “Say what?”

“Born dead, darling”. My ex boyfriend scrawled that over a piece of art work he had created about me, many years ago. I turned the page upside down and scrunched my nose up. Born dead, darling? Quite offended, I had a well-earned sulk. Then he directed me gently to the first letter of each word…

B.D.D.

Body Dysmorphic Disorder was my first ever Mentally Interesting diagnonsense. Long before any doctor saw that I was suffering from depression, eons before a doctor even got a sniff of my mania, I was told I had Body Dysmorphic Disorder.

Body dysmorphia is disabling, but little known. From a psychiatric point of view, it is an Axis III disorder defined in the DSM-IV as:

Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.

The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

A.
B.
C.

The DSM-IV is as dispassionate as always, there.

I tend to think of Body Dysmorphic Disorder as a type of OCD. My symptoms flared up when I was 12- around the same time I had my first manic depressive episode. I would spend all day indoors applying make-up, fixing my hair, my skin, picking away and then I would go outside. I only went outside when it was dark, heavily made-up. In the summertime, I would have an hour or so of socialising before I went back indoors. I waited all day for the moon to rise.

As time went on, I began self harming. I cut the skin I didn’t like, which eventually became everything. I wore huge anoraks all day, every day, to try and hide my repulsive shape. I would get hysterical if anyone tried to take a photo of me. My particular focuses were my weight and my nose. I hated my nose and tried to break it once by slamming my face against a wall. I cut my stomach to try and claw out the fat.

Sounds crazy, I know.

I became a recluse for a long time, and only went out when that manic energy took hold. I loathed every single atom of my flesh.

For the sufferer of BDD, the body is a prison, a horrible, malignant prison.

And I still do, but I’m different now, and this is why.

I never did go to the doctor for treatment. I had a brief period of counselling but my heart wasn’t in it. When I moved to London, my dysmorphia was in full-flight. I hated going out, was terrified of people seeing me. I’ve always worn excessive make-up in an attempt to hide myself.

I began obsessively taking photos of myself. Scrapping photos I hated, treasuring the ones I liked. I showed them to my friends. They would say, “You look like that”. Over and over again, “That is you”. And I liked that image.

I still hate it when people take photos of me. But there are images of myself I like, and cling to. The ones I hate, I abuse, shout at, hiss at. It may seem ridiculous, but this stops me from taking something sharp to my face. In a photo, I can focus my hatred. I have broken down in tears at the sight of my body in a photograph. Yeah, I know.

BORING!

I hear you cry. How many bloody issues can you have, woman? Many, is the answer. But I try not to let my issues PWN! me, as you crazy Internet kids would say. Over the years, I’ve learned to be doctor and patient with myself, getting a neccessary amount of distance to deal with things. I know it’s horrendously self-obsessed. But it stops things from completely taking over. And really, my horrendous self-obsession only exists in Blogland, where I come to lay it all on the table and have a damn good word with it.

Wrongness

Here is a pile of photos of BDD sufferers. Not a bad looking one among them. Still, I think, “I’m the exception. They’re beautiful and I’m ugly”. Nothing special, no big deal as I expect everyone who suffers from BDD things exactly the same thing.

If you click the above link, though, prepare for your, “Hah, people with Body Dysmorphic Disorder are just vain” preconceptions to be proved partly right. In that particular thread, there is a lot of assurance seeking. But people with BDD do geniunely believe they’re ugly. It may surprise you, what with my being level-headed and detached an’ all, but I believe I am geniunely ugly and no amount of flattery and assurances will change that. But that’s my crap to deal with. I have, at least, moved on from thinking that everyone who said I was pretty was a vicious liar. Now I nod sagely with a deflating, “Well, that’s your opinion”.

I am much better than I was. I sometimes don’t wear make-up because my boyfriend says I am pretty without it. A few years ago, I would have thought that people would have been vomiting in the streets at the sight of me without my slap-on. It’s baby steps. But you work through it.

It’s scary to be at war with yourself, and to find cause to wage it. It’s scary to look in the mirror and see nothing but rotted, ugly flesh.

The scariest thing you will ever do is look in the mirror and say, “I look good”. Once you say that, you’re no longer a victim. You’re stronger. You win. So say it.

Belly’s gonna get ya

Ooh. Now I have this new toy, I will probably write in it tediously often.

A common complaint from people taking medication for manic depression is the weight gain. I’m on three “Gainer” medications and, for a while, I outran the extra pounds that were chasing me.

In the past month, I’ve been caught. And pizza has been smeared all over my face.

When I was admitted to hospital in October, I was the lightest I had been in years. Pure manic energy had shaken the meat from my bones. I forgot to eat, forgot to sleep and blubber fizzled away.

Since then, I have gained a grand total of 21lbs. That’s one stone and 7lbs of weight.

I started taken Paroxetine in January. I suspect Paroxetine may be the culprit. It’s an SSRI and, as Crazy Meds lovingly informs us, its side effects are:

The usual for SSRIs – headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Everyone I’ve read on the subject of how long side effects last (Dr. Stephen Stahl’s Essential Psychopharmacology: The Prescriber’s Guide, Dr. Diamond’s Instant Psychopharmacology, Dr. Drummond’s The Complete Guide to Psychiatric Drugs , Preston et al.’s Consumer’s Guide To Psychiatric Drugs) agrees that everything but the weight gain and loss of libido usually goes away within a couple of weeks. Paxil is notorious for having the worst impact on your libido of all SSRIs.

Sounds brilliant, doesn’t it.

It’s been since January that I have gained a ton of weight. Christmas didn’t add a pound to my frame and I came home from Belfast feeling especially smug as people struggled with their belts and picked their teeth with turkey bones.

My smugness has dissolved. I also have PCOS which makes it difficult for me to lose weight in the first place, due to insulin resistance. The most successful weight loss plan I ever followed was The Atkins Diet. It works on people with PCOS as it has a low-carb, no-sugar philosophy.

However, because I now take Lithium, I can’t follow the Atkins diet as I may get kidney failure. Lithium hits your kidneys hard, as does the Atkins Diet.

So, what to do? Technically, I should be exercising my arse off. But you have no idea how hard that is when you take Seroquel. I feel drugged all day. The mists don’t begin to disperse until I’m taking my next dose.

I could go on a diet, but nothing works for me but Atkins. I’ve been eating a lot less recently, but actually gained 4lbs instead of losing them.

I could resort to my old, dear friend, Bulimia. I suffered from bulimia for seven years. It’s only been fairly recently I have got a handle on it. I had a big scare when I choked, went unconscious on the bathroom floor and came to with blood streaming down my nose. It’s fear, rather than sense, that is stifling my vanity.

For the time being, I am trying to be reasonable. It’s more important for me to be stable and used to my medication than it is for me to be thin. And when I feel better, I will start exercising again and hopefully lose weight. I am not dangerously overweight by any means. It’s vanity more than health that makes me sad when I feel the spare tyre around my waist.

I will maintain a sensible outlook for now. It is so very tempting to flush all the medication down the toilet and live like a “Normal Person”. However, I know the consequences of my being untreated. My choices are be fat or be dead.

I’m going to congratulate myself for my logic by ordering a pizza.