Category: Barriers to mental wellness

A Thousand Steps…

If we take a thousand steps, we’ll have travelled some distance whether we’ve reached our destination or not.

Woman descending steps on a mountaintop

Three months ago, I relapsed into a mixed mood state, having symptoms of depression and hypomania at the same time.  This took me by surprise since I had been psychiatrically stable for the past several years.  Why I slipped into this destabilized state, I do not know.

Losing myself

In response to this, the recommendation from my psychiatrist was to double the dose of one of my medications and within a few weeks my mood symptoms resolved and I felt back to my usual self.  Or so I thought.  Sometimes, it’s only in retrospect that I realize that all has not been not so well.  It was only after a month of being a good patient and taking the elevated dose that it was obvious that something was wrong.  I wasn’t having mood symptoms but I was lifeless without any interest in doing anything at all.  I’d just lay around all day not writing, cooking, exercising or otherwise engaging in my life.  This wasn’t depression, it was a side effect of the medication.  I made the decision on my own to return to the lower dosage and a few days later, emerged from my deadened state.  I was alive again.  I know that despite feeling better, on this current regimen, my mood symptoms are going to express themselves and I will become ill again.

The half or zero dose guy

If halving my medication caused me to re-awaken, how could I be sure that the remaining dosage wasn’t having some deleterious effect?  If I stopped taking it all together, might I become even more alive?  Who am I? Am I the half dose guy or the zero dose guy? Am I still trapped beneath the weight of this smaller pill I take everyday?  I’m tempted to experiment and stop all my meds and find the answer.  I understand non-adherence to recommended care.

A thousand steps…and more

I continue to face what many who have psychiatric disorders face.  Still searching, after so many years, for that combination of medications that will stabilize my mood yet won’t suffocate the real me.  As a psychiatrist, I understand the challenges of this delicate balancing act.  That said, I’m rather frustrated and pissed off that I’m forced to continue this wearying journey.  It seems, at times, that there is no end in sight but I have no option other than to soldier on in this (so far) elusive search. I don’t think my feelings arise from a place of self pity. They are instead a sober realization that a thousand steps hasn’t been nearly enough.

I Miss the Mountains

Hijacked by my Brain

I took a hike a few months back in the Blue Ridge Mountains, outside Asheville, North Carolina.  Having scaled one of the peaks, I sat and saw the expansive valley below from my lofty perch.  The sunshine warmed my face as I inhaled the cool, crisp air.  I was on top of the world.

As all others living with bipolar disorder, I had periods when I was driven down to the abyss of depression and then episodes when I was elevated to the heights of mania. I couldn’t predict when my neurotransmitters would hijack my brain but they inevitably would. I was being repeatedly kidnapped.

The Mania of Love

Though my manic periods were ones of agitation and irritability, they were also times of euphoria and grandiosity.  I was the smartest guy in the room, walked with a bounce in my step and felt that I was capable of doing things that were, in reality, well beyond my reach.

When we have a huge crush on someone, the world falls away and all that is rational is replaced with heady infatuation.  In this state, we behave in ways we wouldn’t otherwise, throwing all caution to the wind.  Everything feels tingly, as if we are living on the edge of ecstasy.  This is a small glimpse of what mania is…an other-worldly intoxication.

As a psychiatrist, it was my duty to un-manic my patients.  I was required to shift their state of giddiness into, at times, one of bland sobriety.  I was like a thief in the night, robbing them of what they most loved.  Turning the tables, when my psychiatrist recommended lithium to me in our very first session, I was literally being given a taste of my own medicine.  The psychiatric perpetrator had become the psychiatric perpetratee.

Mountaintop Highs

A few years back, there was a Broadway show called Next to Normal about a mother living with worsening bipolar disorder. Once she was medicated and mood-stabilized, she longed for those periods when she was mountaintop-high manic. She sings:

Mountains make you crazy

Here, it’s safe and sound

My mind is somewhere hazy

My feet are in the ground

Everything is balanced here

And on an even keel

Everything is perfect-

But nothing’s real, nothing’s real

I wouldn’t trade my current mood stability for my prior elevations given the havoc and heartbreak it caused those around me. But, there are moments when I long for my now-medicated-and-absent euphoric core to rule the day and carry me upward toward that place far above. I love ascending the North Carolina peaks but sometimes, I do miss those mountains.

The bumpy medication road to mood triumph

The medication journey begins

When I first walked into the office of the psychiatrist that I continue to see to this day, it was the most humbling experience of my entire mood journey.  I needed him and that really pissed me off.  I was a psychiatrist committing a patient against his will to treatment but awfully, that patient was me.  Seeing him for the first time felt like I was a top gun pilot suddenly forced to sit in coach.  Ugh…I had to submit to care and I felt humiliated.  Before I went, I prayed that he was going to be inept or have the demeanor of nurse Ratchett so I could quit after the first session. But he was surprisingly competent, respectful and understanding.  I hated him for that. The bumpy medication road to mood triumph surprised me.

Photo of man holding many different medications
Photo by Polina Tankilevitch on

I cringed when he recommended the dreaded “L” word, lithium, in the first session. It didn’t surprise me.  The first words out of my mouth when I sat down in front of him were “I have Bipolar Disorder”.  Down the road when he added a fourth medication to my regimen, an anti-psychotic, I had to surrender yet again, this time to the reality of my lack of reality.  That it was being used as an antidepressant and mood stabilizer, didn’t matter.  I now fell into the category of those who had stepped over the line that separates the insane folks like me from everyone else.  I had apparently indeed just flown over the cuckoos nest.  Swallowing my pride was much more difficult than the handful of pills I did each day.

A medication trip of mood triumph

My moods were in a good place as the fog lifted. This took a year and a half and I was prescribed two mood stabilizers, an anti-psychotic and an antidepressant.  It was a stunning experience to be living a life where I wasn’t cycling anymore…it was the first time ever.  My neurochemical mood story turned out to be one of triumph.  And you know what?  For 30 minutes at a time, flying coach ain’t so bad.

Has your medication journey been difficult? relatively easy? Please share