I’ve been following the thread about treatment resistant folks and some of the posts in it really got me thinking. I think it might be time to really re-evaluate my treatment. I want to post a some of my background, what I’ve done for treatment and I’d love to hear any feedback you might have. This is long-- almost a life story and it may trigger some.

My current diagnoses is BP2 with GAD.

It’s time for change. And change is ahead. I’ve had my current pdoc since moving to my current location in Dec. Before that I had another one for a few years.

I’ve had issues since I was a small child. The first time I tried to kill myself I was 5. I had no idea how, and it was ridiculous, but the intent was there as well as the effort. My teen years were hell with lots of mutilation, drug abuse, terrible relationships, suicidal ideation and so on. When I drank I’d freak out and become violent and/or suicidal, so I tried to stick mainly to drugs.

In my late teens I went through a phase of cutting that I thought was suicide at the time, but looking back most of it was self mutilation. Not all of it though.

In my early 20’s I had a toddler and a baby. I went to re-hab, joined 12 step programs and became a recovery NAZI. I drank herbal tea and lived a clean life. I thought I was “better.”

While visiting family in another province, I met someone. When I went home we exchanged letters and developed a phone and letter romance. I went to visit him, decided on impulse to get married, went home and packed up and moved my two small children all the way across the country and through three time zones to be with him. I’m BP2 but I’ve wondered over the years if this period of time could have been mania. But I’ve never heard voices or anything like that, and I can't remember enough to know if I was very delusional. But I certainly behaved as though I was. I know the people back home who knew me were begging me not to do something so rash, but there was no way I was going to listen to them.

He was a horrible person. Absolutely nasty. The kind of guy who practised psychological abuse like it was a fine art. I ended up in the hospital maybe four times or so in the 5 months I was with him. Ended up in ICU after OD’ing and then a friend flew out to stay with me and bring me home.

Once there I was on a mission to destroy myself and my life got even messier. Promiscuous, drugs etc. I ended up hitting bottom and I went to a residential treatment facility for 5 months. It was absolute hell. There were 5 or more intensive sessions of therapy per week, plus a few that were more like group and conflict management. The whole place was trigger after trigger and they wanted it that way. If they saw a trigger they dug right in. The program has since changed as it was dangerous the way they ran it. I survived it and it made me stronger.

So I went from rocky teens, to wonderful early 20’s where I thought I was better, then went up, up, up and married a monster on a whim, plunged down to a very dark and dangerous place and that lasted for months.

After the residential treatment, I was doing a little better, started university as a mature student and thought my life was on track. I was better now. I’d done the treatment and now was better.

A couple years later I had met my husband and we were living together. Everything was stable. I was happy, and my life was great. But I couldn’t leave the house I was so depressed and the thought of seeing anyone made me panic. He would coax me out to the all night store in the middle of night just to get me out of the house even if it had to be under cover of darkness.

I went to see my doc and she finally acknowledged that I had a problem. It was because there was no turmoil at that point and she could see that it was physical. She put me on an anti-depressant (Luvox and then later switched to Effexor) and a couple of years later I happened to be talking about how I was cleaning and organizing my house and she started to question me about hypo. She was only a GP but the town I was in was under serviced and pdocs were in very short supply, even for people with serious psychosis. She diagnosed me as bipolar and added a mood stabilizer (Valproic Acid).

I immediately gained 30 lbs and stayed on those meds for years, but I still cycled.

All along I have also had these weird episodes. As I was going up or down, I would often have a crisis. I would panic, melt down, lash out and destroy things (often walls). I would also punch myself in the head, feel extremely violent (with myself or things only). I would hate myself, feel panic at the world, completely overwhelmed and become convinced that I HAD to die. My hubby has had to restrain me at these times. These episodes would happen in a major way once or twice a year, with multiple milder versions (throwing phones, glasses, yelling) in between.

So I was on these meds, still cycling and still having these episodes.

Then I got very sick from the meds (Valproic Acid and Effexor) and had to be taken off. My GI specialist told me not to take any psychiatric meds. My Dad had just died, then my beloved dog unexpectedly and I slipped into a depression that was the most severe one I’ve ever had.

I was almost catatonic. I could only sit and stare. I couldn’t concentrate enough to read, or watch TV or play video games which were my usual coping strategies for depression. I literally sat and stared for hours and hours on end for months, barely able to speak. I was locked in my head with a suicide fantasy playing over and over in a loop that wouldn’t stop. At first I recognized it as suicidal ideation and dismissed it, but it persisted and I began to notice it more and pay attention. It started to crystalize into a plan and I was afraid. I told my hubby. Ironically, while I’ve been suicidal at various points, I really don’t want to die.

There was some talk of me being hospitalized (this smug little prick of an intake worker even insinuated that it might be done against my will) but it was a small town and my hubby is a cop so I didn’t feel like that was an option, and my hubby felt like a contract would be enough. I had been told that I couldn’t get a pdoc because the waiting lists were too long but one was obtained and I started going.

I disliked him and I think he was sexist and I was never comfortable with him, but he put me on meds. Seroquel and Lamotrigine were starting to be used as treatments for bipolar and he had just read about that combo in a psychiatry magazine. They seemed to work for the most part.

I still cycled, and I still had my episodes (we replace a lot of phones and I’ve attained some skill in patching drywall), but I didn’t sink as low as I’d been, so I felt that he’d saved my life. I was still debilitated for some months of the year, but I had my hypo states to catch up on what I’d missed, and compared to what I’d been like, I felt like I was functioning okay. Each time I had a melt down I felt like killing myself for a few days, but then I’d usually swing up after the initial crash down and each time I thought it was a one-off. I didn’t recognize these episodes as being part of a pattern. I saw them as events caused by external factors.

When I moved and got another pdoc I told him that I was doing fine. I was cycling between hypomania and severe depression, but as the depression was not the nightmare I previously experienced, I dismissed it as part of my cycle and as normal. I accepted it.

My depressions would last for weeks (5 or 6 maybe) but not months and I wasn’t always rock bottom. I might isolate in my house, but I could get out of bed and leave my bedroom. I would play video games, watch TV and hide as a means of coping. When it got too deep, I would lie in bed and stare, but I wasn’t like that for months on end and I could endure it.

I thought this was as good as it would get and I was content with it. I had my coping strategies. I could do whatever I do when I felt good. When I was starting to get depressed I would "put on my seatbelt" and settle in. I would do things to pass the time until I felt better and then when I'd swing up, I'd cook and clean, write, draw or take pictures. Call all the people I'd been avoiding and tell them I was back.

My pdoc told me he didn’t think I had very good quality of life. He wanted to treat my hypo and said it could make my depression go away. He put me on Lithium.

Looking back over the past two years I can see that my life has changed. I no longer cycle much. I am depressed much more often and there is hardly any hypo to relieve it. I stay depressed for longer periods. It's as though now that I don't have the hypo to pull me out, I stay locked in the depression for the time I would have been up. I have been depressed for probably 10 months out of the year since I’ve been on it.

I have blamed it for taking away any passion I have but I don't know if I only feel that way now because I’m depressed. I know I've felt that way, then changed my mind when I've felt okay. What I do know is that I haven’t been creative or felt joy or passion since I’ve been on it. I have also been depressed so much more. But....I also noticed that my outburst episodes had disappeared along with the hypomania as well, and thought that since the lithium was treating them it was okay after all.

Until a month and a half ago when I had a doozy. I destroyed a wall, broke an iphone and a laptop and my hubby had to restrain me. I felt like going to the hospital. I have Zyprexa as a PRN for these episodes but while I took it as soon as I felt myself start to escalate, it didn’t kick in fast enough. After it hit me I slept for a day and wanted to die. It makes me soooooo depressed when I take it.

My current doc put me on Welbutrin after that. I was having a hard time at first with side effects as I’m very sensitive to drugs. I was determined to ride it out and give them a fair try so I did but at my last visit he asked and I told him I didn’t feel any less depressed. So he suggested ECT. I’ve been on meds for 19 years and they aren’t working :-(

In preparation for my ECT he is taking me off of Lamotrigine and he will be taking me off of Lithium as well. I’ve been having some trouble coming off the Lamotrigine, but the last day or two has been better.

I was really intrigued by a few posts from a couple of people who use meds only when they need it and not all the time. Since I cycle anyway, I’m wondering if I should look at that.

If I understood my pdoc correctly, it sounded like I might be able to go all the way off some (if not all meds).

I’m excited about the ECT and I really hope it works. Whether it does or doesn’t, I really feel like I need to look at what I’m doing.

My questions:

When I married that guy, would that have been hypomania or could it have been mania? Would a person do something that extreme while hypo? If it was mania, is it possible to have mania but not hear voices, or have any noticeable psychoses?

Could my outbursts be mixed episodes? They usually take place in the company of a lot of anxiety and depression. I feel crappy, and then agitated and that becomes a sort of panicky rage. I will say whatever I'm thinking at this point no matter to whom and no matter what. I would not trust myself in public like this. What I say is always the truth (or how I feel at the time), but it cuts and my delivery is usually scathing and brutal. I don't feel in control of myself.

I lifted this from a journal entry I did: The most frightening type of suicidal episode for me has been there from the beginning and remains with me still in some form or another. It is frightening because unlike the deliberative and self-indulgent episodes I describe above, I do not feel in control when this takes place. When this takes over, my emotional state escalates to a level where I feel very little control, and when thoughts of shame, guilt and self hatred are present, I feel a compulsion to act instantly and violently and I shake and cry silently and frozen with the effort to stay still and wait long enough to get a fast acting medication which has saved me (and my loved ones) a lot of grief. In these episodes I feel like I could murder myself quickly, decisively and it a fit of rage.

Finally...any suggestions?

I was going to apologize for this being so long, but I warned about at that up front, so I assume anyone who got to this point chose to do so because they were interested. Since that is you, thank you for reading :-)