My medication history

I have a long and arduous history with medications. Sometimes, it takes quite some time to strike the right balance with meds and bipolar disorder. This is my own personal review of each medication I’ve been on. There’s a lot! My reviews won’t necessarily be applicable to other people because each person’s response to a medication is different, but hopefully this provides some sense of just how many trials it can take to find something that works.

Stimulants

Adderall — amphetamine salts, a classic stimulant drug. Adderall XR is an extended-release preparation. For some reason the XR didn’t work well for me. I still take the IR daily.

Ritalin — methylphenidate, a different stimulant drug. It has important differences from Adderall and may work better in some people. Slightly different forms of Ritalin go by other names, such as Focalin.

Vyvanse — basically a different kind of Adderall XR,; it is the same molecule as Adderall with an extra group attached that renders it inert, which is then cleaved in the liver over time to release Adderall. To me it feels less effective than Adderall, doses held equivalent.

Mood Stabilizers / Anticonvulsants

Lithium — I’ve taken doses ranging from low to high (currently I take a high dose). Lithium dose is measured by the concentration of it in your blood; the highest dose varies depending on individual differences. You do get frequent blood tests while the ideal dose is being determined, and less after that. It is incredibly effective for many people. Because I’m on a high dose, it sometimes makes me nauseous or makes me throw up, and my hands tremor quite a bit. The cognitive side effects are the worst, but they get better over time. 

Lamictal — lamotrigine. For some people with bipolar disorder, lamotrigine is a better drug than lithium. It is not strongly anti-manic (unlike lithium), but for some this may not be a problem; however, it may be superior at treating bipolar depression. Rarely, it can cause a horrifying skin reaction when you first start taking it (and for that reason, titration takes forever — for me, I believe it took 5 weeks to reach 200mg). Past that initial window, it is considered to have very few side effects.

Depakote — valproic acid. It’s more anti-manic than lamotrigine. It smells terrible, yet apparently it comes in a form designed to put in a patient’s food which psychiatrists call “Depakote sprinkles”.

Gabapentin — I took it for anxiety, and it did put me in a good mood, so I suppose it worked.

Antipsychotics

Seroquel — quetiapine. People pronounce it in wildly different ways, I say “kweh-tie-ah-peen”. It helped with my mixed episode, but eventually it lost effectiveness and I found myself staying awake all night on 800mg (that’s a lot of Seroquel). Basically, it’s good for putting you the fuck to sleep, or at least it should be.

Zyprexa — olanzapine. It made me gain a lot of weight. It was fairly effective, but I had to discontinue it due to problems with my liver and its effect on my metabolism. It’s also pretty good at putting you to sleep. I preferred the sublingual form during my inpatient stays (it’s vaguely citrus flavored) because it made me feel better really quickly when I was agitated.

Abilify — aripiprazole. This drug actually helped me for a long time, and it still seems to have some effectiveness but I developed a facial dyskinesia while taking it. That’s an involuntary muscle movement, in my case of my lower left face. This was thought to be uncommon at first, but it turns out with long-term Abilify use (4 years for me), it’s quite possible. I can’t take any drugs related to Abilify anymore — these include Vraylar (cariprazine) and Rexulti (brexpiprazole). Abilify is not usually good at putting you to sleep, but when I started taking it I was on a dose that was too high for me at the time and I was very somnolent most of the time. 

Geodon — ziprasidone. I felt well but it made me throw up a lot. I discontinued it and got some Zofran from the ER. You have to take it multiple times per day, so you hope it doesn’t put you to sleep. I usually did have to take a mid-day nap.

Latuda — lurasidone. You have to be sure to take it with food. It wasn’t very effective for me. 

Saphris — asenapine. Warning, it only comes in a sublingual form and it’s cherry flavored. Nope. I only took it once and I had nightmares about cherry flavor afterwards.

Clozapine — I didn’t actually take this one, but it was on the table. I chose Haldol instead. It is probably considered the most powerful antipsychotic because it has been shown to break through where other antipsychotics have failed, and it was the first “second-generation” or “atypical” antipsychotic. However, it is quite possibly the single most dangerous drug in psychiatry — the potential side effects include a catastrophic loss of white blood cells, among other serious effects. It’s a “drug of last resort”.

Haldol — haloperidol. Haldol is an older drug, one of the “first generation” or “typical” antipsychotics and it is the most potent among those, also with the highest likelihood to cause dyskinesias (including tardive dyskinesia, which is permanent). These side effects have led to the popularity of the “atypical” drugs listed above, which are less likely to cause dyskinesia. Haldol is very effective for me, and I don’t find it sedating at all (which is a blessing and a curse). Having taken most of the atypicals available in the US (except for clozapine, paliperidone, risperidone, and a couple others that are much more rare), I was surprised at how not sedating it is.

Thorazine — I haven’t taken this one either, but it’s been on the table because of its more favorable side effect profile. It is the original antipsychotic drug, from which tricyclic antidepressants were also derived. It has more action on the histamine receptors than Haldol, making it much more sedating. However, this also makes it less prone to cause troubling dyskinesias — for example, antihistamines are actually a treatment for dyskinesia.

Antidepressants

Prozac — fluoxetine. It’s pretty much the basic SSRI. It didn’t do much for my mood at the time. It’s often used in combination with olanzapine/Zyprexa.

Lexapro — escitalopram. It’s an SSRI, and it has high selectivity to affect serotonin reuptake and not norepinephrine reuptake, in contrast to Prozac (which is not very selective). I took it for anxiety and OCD symptoms; I wasn’t convinced it was effective. It also changed my sexual functioning for the worse. 

Wellbutrin — bupropion. It’s an atypical antidepressant that affects norepinephrine and dopamine uptake. I took it to help with smoking cessation. It did make cigarettes taste bad, but I continued smoking them and within short order the drug made me manic.

Trazodone — an atypical antidepressant and an oldie but goodie. This one puts me to sleep (most of the time), and thank God for that.

Remeron — mirtazapine. Another atypical antidepressant. Usually a sleep drug, sometimes used for straight depression, also a great anti-emetic (anti-nausea drug).

Benzodiazepines

Xanax — the only time I took Xanax was recreationally, but I didn’t feel very enamored with the experience. Xanax is highly addictive, I suppose some people find it euphoric in a way. 

Ativan — it’s like toned-down Xanax, it is quite effective but it’s not as euphoric. It has helped me in ways other drugs couldn’t, although whether I would recommend them would be situational due to the addictive potential.

Valium — I’ve only gotten it in the ER, but it lasts longer than Ativan.

Others

Propranolol — a beta blocker, it helps me with akathisia (a side effect of antipsychotics).

Cogentin — benztropine. An antichonlinergic drug used to treat the side effects of antipsychotics. I didn’t take it for very long.


What’s it like to be in a psychiatric hospital?

I’ve been hospitalized 17 times. At this point, it seems perfectly routine. I pack my carry-on suitcase, grab my Pikachu stuffie, and I’m on my way. I know what to expect. However, whenever I’m in the “psych corner” of the ER, there’s always someone being admitted for the first time, and they’re usually crying. I cried during my first admission, too — my therapist told the police to wait until I stopped to put me in the car. I’d read about the hospital online, but still, I didn’t know what to expect and I was very scared.

So, if you’re ever hospitalized, here’s what to expect.

Limited Choices

Where you can go, what you can do, and even what you can eat are very limited when you’re in the hospital. Psychiatric units vary in size and structure, but it will likely be smaller than you would like. Everyday choices are made manageable for people with acute psychosis or severe mood disturbance, which means there are not very many choices.

Here are some activities which are generally allowed, and which I personally recommend:

  • Reading books. The choices of books on the unit are likely to be very slim, so I recommend bringing your own books. Easy to read books may be for the best, as medications can make reading challenging; I enjoy middle grade and young adult fiction.
  • Talking on the phone with friends and family. There is always a phone. I have been in really outdated units where the phones were actual pay phones that required quarters… but in my experience, this is very rare. Phones are usually made unavailable during groups and meal times.
  • Talking to other patients. The other patients in the hospital are likely to be interesting. Some of them will seem “normal” and some of them won’t; a few may be very agitated or aggressive. Don’t be afraid of them, they don’t mean you harm and if things get out of hand the staff will know what to do. It’s a good opportunity to get to know other people with mental illness, and I’ve had many interactions which I’ve remembered for years.
  • Card games. Sometimes there are board games, which may or may not be in playable condition, but there is almost always a deck of cards. Playing cards is a great way to pass time and interact with other patients at a level that isn’t very demanding. I learned to play Rummy 500 in a psychiatric hospital!
  • Take a shower. It’s easy to forget that you need to shower when everyone is wearing pajamas and look like they’ve been in bed for a year, but showering is something that can affect how the psychiatrists see your level of functioning. It’s also a way to pass time in itself. Sometimes you can bring your own shower products and deodorant, which I do recommend because it will make it seem like you’re doing your whole routine.
  • Go to groups. There will likely be a few groups throughout the day, particularly on weekdays. They are likely to be somewhat simple and plain, which makes it so everyone can participate as much as possible. Going to the groups is probably the single biggest action you can take to expedite your discharge. It’s not the only factor and it won’t make a miracle, but it’s worth a try.
  • Go outside. There will be some kind of small outside area. Sometimes it’s on the roof, sometimes it’s a courtyard or a fenced-in patio. You can usually go outside at designated times during the day, weather permitting.

What to bring and what not to bring

Hospitals do vary in their policies and if possible, you can look up their website or call in advance to see what they allow. But this often isn’t possible because when you go to an ER for psychiatric reasons, you could be (and often are) sent to a completely different hospital. Therefore, use your best judgement and pack what you can. I pack a small roller suitcase so that I can fit everything I want.

  • Don’t bring electronics. Cell phones will not be allowed, nor laptops or tablets, or anything that has the ability to take photos, record videos or audio, or access the internet through a browser. However, there are a few exceptions which may be made at some hospitals — UCLA has allowed me to bring old Game Boy consoles, which aren’t capable of anything except playing the inserted cartridge; a basic Kindle e-reader; and an MP3 player with Bluetooth headphones, no wires and nothing with any of the aforementioned capabilities. Bring chargers for your phone and any of these items if you bring them, but be aware you won’t be allowed to charge in your room and staff will supervise your items while charging. (P.S. I’ve heard that electronics are allowed in the UK, so I can only speak for the US.)
  • Bring a light jacket. If you live in a cold climate, you can also bring an outside jacket, but you will want a light jacket for inside the hospital because it’s usually a little bit cold in hospitals. If you bring a hoodie, make sure it does NOT have strings; the same goes for sweatpants and shorts. Strings will probably not be allowed.
  • Bring clothes that make you feel normal. Some people will specifically say to bring comfortable, casual clothing. That is a good idea, but I think the most important thing is to bring clothes that make you feel like yourself, because it’s very easy to feel disrupted when you’re in such a different environment than your usual life. Don’t wear a tuxedo or a $500 designer item, because you’re probably gonna spill cranberry juice on it and you know they wash everything on hot, but wear whatever you want — as long as it doesn’t have strings.
  • Bring slip-on shoes. Some hospitals will not allow you to wear shoes at all. The fancy hospital socks with treads on the bottom are very real, and you’ll get some in the ER. If shoes are allowed on the unit, you’ll have to take the laces out, so bring shoes without laces. Definitely don’t bring boots or anything with a heavy sole, as those will probably not be allowed.
  • Bring books.
  • Bring shower supplies and deodorant. It’s not essential, so if you don’t have space, don’t bring them. But I like them.
  • Bring a comfort item. I always bring my jumbo Pikachu stuffie. Something small would work, but I’m excessive.

Things to be aware of

  • Quiet room. That’s a euphemism, for sure. Most hospitals have one although I think at UCLA they just move you to a different unit if you’re in that place. Basically, this is where they put people who need to calm down. Injectable medications (seems like Zyprexa or Haldol, usually) are often involved, as are restraints. It might actually have padded walls like you see on TV. But if you’re worried about going there, in my experience, you’re probably not going there.
  • Furniture. You won’t notice this until you’ve been in a few hospitals, but they all have a similar physical design with very similar furniture. That’s because they’re designed so you can’t tie anything onto them, if you were to have strings. All safe furniture looks pretty much the same, and it’s very 70s for some reason.
  • Smoking. There are a minority of hospitals that still allow you to smoke cigarettes at designated times. Feel free to bring your preferred kind if you do smoke, but don’t load up; in hospitals I’ve been where smoking is allowed, there are usually house cigarettes available. They are very cheap and seem to be made with cigar tobacco, but trust me, it’s better than nothing.
  • Voluntary status. Not to scare you, but even “voluntary patients” are not 100% free to leave whenever you want. It is better to be admitted voluntarily than involuntarily, but if you do try to leave on a voluntary basis and your treatment team feels strongly that you’re not ready, your status can be changed. At least, mine has been in the past. So it is kind of a catch-22 situation. Some hospitals are more mindful about this than others. It also seems to vary by state.

I hope this overview has been helpful. And if you’re ever hospitalized, don’t worry; it is an adjustment, but most people get used to it very quickly. It’s designed that way. Meals, groups, outside breaks, and pretty much everything will occur at the same time every day. It’s weird how you start to feel hungry for dinner at exactly 5 PM. But it happens quickly!


How I explain bipolar disorder to people

I’m quite open about my bipolar disorder diagnosis (partly out of necessity) and so, I often get asked questions like, “What is bipolar disorder really like?” I’ve come up with a few good answers to explain to curious friends, family, and coworkers the reality of bipolar disorder in a way they might understand.

1. It’s kind of like epilepsy

Although bipolar mood episodes occur on a longer timescale, a mood episode has a lot in common with a seizure. It can be triggered by something or it can come on for seemingly no reason, and the person has little control over it (although to some extent we control our actions in response). It can end spontaneously or with medical intervention.

Recently, overlap in the neurobiology of bipolar disorder and epilepsy has been discovered. In fact, some medications that are effective treatments for epilepsy are also very effective treatments for bipolar disorder — prominently including Lamictal and Depakote, but also others.

2. Technically, mood episodes last 1-2 weeks or more

At least, according to the DSM (a manual of diagnostic criteria for mental disorders), they do. But that isn’t always the case and many experts dispute these requirements as being too restrictive in real life. My own bipolar disorder is rapid cycling, and I can have episodes that last for only a couple of days.

3. Mania isn’t happiness

Most people understand that depression encompasses sadness, although it also encompasses feelings of emptiness, numbness, profound lethargy, and irritation. They assume, then, that mania (being the “opposite” of depression) is a state of happiness or euphoria. This can be the case, but it often isn’t; mania can be angry, agitated, restless, irritable, confused, and it may include hallucinations and/or delusions which can be very scary or troubling. Further, mood episodes can be of a mixed type, including both manic and depressive symptoms. These can occur at the same time or in a rapidly alternating fashion. Mixed episodes are actually quite common.

4. There’s one symptom that is practically universal

And that’s changes in sleep. During mania, people sleep less — they may not even sleep at all. Research has shown that sleep changes actually precede manic symptoms; they may be the very first sign of a manic episode.

Meanwhile, people with bipolar depression usually sleep too much. Some experts (including my psychiatrist) believe that when people with depression severely oversleep, it’s a sign that they have latent bipolar disorder (which is to say, they just haven’t had a manic episode — yet).

5. There’s a pattern

One of the differences between bipolar moods and “normal” moods is that, in the majority of cases, there’s a distinct pattern to bipolar mood episodes. They don’t occur in a random order. Most people have either mania then depression, or depression then mania. It’s rare for people to flip between them. So, somebody that starts with depression will typically always start with depression.


So, that’s what I explain! Have you ever been in this situation? What did you say? Leave a comment!