First Year on Lamictal: Efficacy and Persistent Side Effects

I started this blog one year ago today.  Since then I've been through a lot: marital problems and the loss of the two cats who'd been keeping me sane all these years.  And that's not even getting to the drugs.


Ah yes, the drugs.  I'm on a lot of things besides 300 mg of lamictal.  I'm also on 5 mg of Abilify, 70 mg of Vyvanse (for ADHD), 1.5 mg of Ativan, and (soon) 5 mg of Adderall (also for ADHD).  That's not even getting to my allergy meds.  I worry about my liver sometimes.


But this blog isn't really about the other drugs, it's about my experience with Lamictal -- how it's affected my mood, and what side effects I've had to put up with.


Lamictal has definitely stabilized my mood.  A year ago, my mood was more positive than not, but still unstable.  At 12.5 grams of lamictal, I started to feel better, but I definitely still experienced my 3pm to 7 pm trough.  I didn't start to feel stable until I hit 100 mgs.  I titrated up to 150 mgs, and did pretty well until the Autumn Equinox.


Since my depression is so sensitive to light, I went up to 200 mgs and broke out the sun lamp.  As the days continued to shorten my mood continued to destabilize.  After a few weeks at 300 mgs, I needed to start Abilify to smooth things out and to ease my depression.


I've been pretty stable since then, especially considering the deaths of my two cats in the space of two and a half months.  The cast have thrown me for a loop.  I'm sleeping more, and my motivation is shot to hell, but soon I'll be taking Adderall in an attempt to address that.


And now is the part where we address the side effects.


Lamictal seems to rewire your whole nervous system.  Like other brain meds, you might get headaches, dry mouth, dizziness, gut trouble, and sleep disturbances.  Unlike other brain meds, it affects your skin, muscles, sense of balance, and sometimes your bladder too.


Personally, I've experienced everything but the headaches (and the dreaded Stevens-Johnson syndrome) at one time or another.  Here's the breakdown:


Urinary Problems


I occasionally have trouble peeing, and this has been especially true since starting Abilify.


GI Problems


I've had occasional diarrhea and loose stools, but by far the worst thing was the severe constipation I experienced at 200 mgs.  The weird thing about this is that I had no constipation at any other dosage.


Sleep Disturbances


In the beginning, I also had severe sleep disturbances (this is by far the biggest side-effect tag on this blog). The meds gave me delayed sleep phase -- I could sleep a normal eight hours, but only between 3 am and 11 am.  Since I had been sleeping much more normal hours, this was incredibly frustrating.  This problem went away when I started using my sunlamp in the Fall, and it hasn't returned since I stopped using my sunlamp in the Spring.


Balance Problems


Before I injured my shoulder, I was lifting weights a lot.  As I recover from my injury, I'm doing yoga.  Both exercises require pretty good balance, and I notice that I sometimes have more trouble with this than I used to.  However, it's gotten better the longer I've been on my meds.


Muscle Tension


This is actually a positive side effect.  Whereas some folks notice that they're muscles are tight and sore, my muscles have loosened up significantly.  I'm much more flexible, and I don't get delayed onset muscle stiffness anywhere near what I used to get.  (Delayed onset muscle stiffness is that thing where you get stiff and sore hours to days after exercising).  Since I was lifting weights, and plan to return to lifting weights, this is pretty sweet.


Skin Problems


Aside from the Dreaded Rash of Deadly Doom, aka Stevens Johnson Syndrome, lamictal can mess with your skin in all kinds of ways.  And indeed, I've had skin issues since Day 2.  Anything that happens to my skin seems to be amplified, whether it's heat rash, sunburn, or insect bites.  This is another side effect augmented by Abilify (which actually warns you away from direct sunlight).  


To give you an example, a month ago I wrote about a sunburn that I had gotten three weeks previously.  It was still messing with my skin.  It has now been eight weeks since that sunburn, and my skin is still a weird texture, and it only stopped peeling a few weeks to.


The moral of the story is, SUNBLOCK.


The Most Important Thing I Have Learned About Lamictal


One of the posts that makes the consistent top five on this blog is the one about where to find Teva lamotrigine.  Why does this matter?


For whatever reason, lamotrigine's bioavailability can vary by something like 20%.  Isn't it great that we regulate drugs in this country?  Anyway.  If you want the same bioavailability as the brand name, you need the Teva generic.  I personally had a disastrous experience on the NorthStar version, and I know I'm not the only one.  I got the NorthStar version at the Costco Pharmacy.  As for Teva, Walgreens always carries it.  To be safe, I fill my scrips at Walgreens. 


And that pretty much wraps up my first year on lamictal.  This blog has gotten 11,538 page views since its inception a year ago.  I hope it's helped a few people along the way.

My kitty is going to be OK!

I wrote a few days ago that my cat was very very sick, and I was expecting the worst.  Turns out it's only IBS.  She's on prednisone, an anti-inflammatory that will also make her hungrier, and I need to get her to eat bland food like simply-prepared chicken.

This is such a load off my mind.  Of course, a lot of my time is still spent trying to entice my cat to eat, which is time consuming and frustrating, but now that I know she's improving it doesn't make me as incredibly sad as I was a few days ago.  My mood has improved by a factor of a hundred.  So has my motivation.

Big sigh of relief!

Lamictal 300 mgs, Abilify 5 mgs: I Feel Like Myself Again

Last year at this time, though I didn't realize it, I was working incredibly hard -- and all the time -- to manage my psychotic depression.  My mental energy went to reigning in bizarre thoughts, or to distracting myself by fixating on an art project, or by obsessively cleaning the house.  It was exhausting.  The antipsychotic medication helped a lot, but it didn't fix it.

This year, I've been on lamictal, and the difference is like night and day (which is good, since my delusions were about photons).  I was able to see just how hard I had to work last year to keep the crazy at bay, and how this year, I simply didn't have to put in that effort.  Yay lamictal!

Nonetheless, I was still pretty moody by early December.  Overall my mood was better.  I no longer had to listen to cheerful, energetic music to keep myself from becoming untethered.  Sometimes I could even listen to a sad song without totally losing it.

Weekly Gratitude: My Cats, and Cats In General

Fair Warning: I love cats.  I've loved cats for as long as I can remember.  I am a cat person.  In this post, I gush about my own cats at length.  If you're a crazy cat person, read on.  If you're not, this post may make you roll your eyes at the sentimentality of cat people and go talk baby talk to your poodle, Fifi.

This week I'm giving gratititude for my cats.

There are a lot of things I love about my cats.  They're both incredibly well-behaved, with never a litter box problem from either one of them.  They don't shred the furniture.  They don't bite or scratch.  For that matter, neither one of them has even so much as hissed at me in the 16 years we've lived together.  They really are great cats.

I really, truly enjoy my cats' personalities.  They differ dramatically from each other, and complement each other perfectly.  First, there's Piglet, a mellow, affectionate, 16 lb Maine Coon mix.  If I want a cat in my lap, I can just pick her up and put her there, and she'll start purring like a motorboat.  For that matter, she likes being picked up and held on her back like a baby (most cats hate this), and purrs like a motorboat the whole time.  My husband can position her on his chest and fall asleep with his arm around her, and she'll stay there for hours ... purring like a motorboat.  She even allows herself to be used as a pillow.  Did I mention she purrs like a motorboat?

Fortunately, Piglet is so mellow that she doesn't mind being bossed by our other, much smaller cat.  CC is a 9 lb blue tabby.  If she even looks at Piglet in a certain way, Piglet will make a long detour to go around her.  If both cats were dominant personalities their relationship would be a real problem.  But Piglet is happy to back off when CC gets obstreperous.  The cats aren't friends, but they live in peaceful, mutual tolerance.

As for CC can be affectionate, but it's always on her own terms.  She expects obedience from her human minions.  The back door is opened when she asks (she trained me to open it when she rings a bell on a scratchy toy that hangs from the doorknob).  She demands a certain amount of play time every day.  She's sparing in her affection, but if she wants some lap time, she simply takes over my lap.  If she doesn't want cuddle time, there will be no cuddle time.  Until she wants cuddle time again.  Which is usually at 3 in the morning.  Because CC -- disdainful, independent CC -- actually sleeps snuggled in the crook of my arm, and purrs all night long.  (Though possibly this is simply due to amusement; my partner and I frequently wake up to find that we've somehow been crammed onto his half of the bed, and CC is in the exact middle.  CC weights 9 lbs, remember.  My partner and I weigh about 330 combined.)

It's a lot of fun to have one cat you can always count on for some love, and another cat you can tell great stories about.

My cats do have one thing in common.  They both take care of me when I need it.  When my mood begins to crash, Piglet butts her head against my legs until I start petting her.  She crawls into my lap and rests her head against my chest.  CC normally hates to be picked up, but when I start crying, she rubs against my legs and yells at me until I pick her up.  My cats soothe me.  They remind me that I am not my failures.  When I'm feeling useless, they remind me that they depend on me for survival. I feed them and love them and take care of them, that's good enough for them.  I'm good enough for them.

Happy First Psychoversary to Me!

I've made it past the one-year mark of my first (and worst) psychotic episode!

I know that I've been doing better this year -- no delusions in October that get progressively worse through November -- but I've nonetheless been very apprehensive about early December.  That's when it all hit the fan last year.  That's when I had to start covering things in foil.  That's when I went on Abilify for the first time.  And it wasn't as an "add-on treatment for depression", and it wasn't as a mood stabilizer like this year.  It was an antipsychotic.  I was taking it to control my psychotic delusions.

I've still been moody as hell.  The lamictal has helped a lot, though clearly not enough; As I've titrated up, my mood has risen and stabilized, only to fall and destabilize as the sunlight decreases.  But I haven't had a single delusion.

I received my diagnosis of psychotic depression one year ago today.  Passing this milestone feels huge to me, like I can begin hoping for a full recovery.  I feel like I deserve to celebrate!  Any ideas how one celebrates a psychoversary?  Please, please share in the comments.

Lamictal 300 mgs: Plus 2 mgs Abilify, minus 5 mgs Adderall

The short version: my mood has been all over the place for the last week and a half.  My pdoc had two options.  Number 1: Go back on 12.5 mgs of Zoloft, which would numb me out a bit, and shouldn't give me SSRI problems because they'd be tempered by the lamictal.  Or, number 2: go back on Abilify for the short term at a very low dose; I'd still feel my feelings, but I won't be reduced to tears over stupid shit.

In other words, the lamictal is helping a lot with the depression, but it's not stabilizing my mood as much as it needs to, and it needs help.

We decided to try Abilify first. We know from past experience that it will work immediately.  I also think it's important to feel my feelings; I just need not to be completely overwhelmed by them.  I feel pretty good about this.  I can start it tomorrow and stop crying like an emo kid.

We're also removing the Adderall from my cocktail.  After two weeks it's clear that while it does help my mood, it doesn't help enough.  It also wreaks havoc with my sleep.   Unless I can be sure to squeeze in some seriously vigorous exercise, and I can't always do that, and messed up sleep equals messed up mood.

A few words about my mood lately.  At some times I'm feeling really good, almost too good, and for no particular reason.  Then if I'm triggered (or sometimes when I'm not), I crash and crash hard.  I start sobbing and simply can't talk myself down, let alone stop, for several hours.  When I finally do, I last about ten minutes before I start sobbing again.

What do I mean when I say "stupid shit"?  Well, let me tell you about the day after Thanksgiving.  We like to cook our own small turkey, because we like to do things with the leftovers.  But, unbeknownst to us, the turkey was partially frozen.  It probably was up against the side of the refrigerator case or something.  Anyway, it took all afternoon to cook (way too long for a 12 lb turkey, so I was already crying about that).  Then we cut into it, half of it was raw.

The rational side of my brain, and my husband, told me that this wasn't my fault, and that we could just use the turkey for stock, so it wouldn't be a total loss.

The crazy part of my brain was in tears because I'd wasted all day and my husband was sick so he couldn't help me cook so we hadn't spent time together and he was leaving the country the next day AND I RUINED THE HOLIDAY!

Don't even ask what happened when he returned from his trip and didn't immediately give me a hug.

I can't be crying so much that it interferes with my life.  And with my husband probably also being depressed, I can't be triggering that feedback loop where does something without knowing it will upset me, and then I start crying, and then he feels bad for upsetting me ... and gets stressed ... and I feel bad for stressing him out, so I cry more ... and he withdraws from me emotionally ... so I get more upset ... and the cycle begins anew.

To wrap up: Abilify.

Oh Yeah, My Mood Action Plan

My experience the other night made me remember that I'd created a Mood Action Plan back in the day.  I've printed it up and posted it above my desk/studio table.  I've already acted on some of them -- namely those that deal with my daily mood crashes:

• Troughs or crashes in mood between the times of 4 and 8 pm become more frequent
• Troughs or crashes in mood between the times of 4 and 8 pm become worse (tearfulness, paranoia about relationships, pessimism running to despair)
• Troughs or crashes in mood lengthen beyond the 4 to 8 pm range

All three of these symptoms are occurring, a fact to which I have alerted my pdoc (which was action number 1 on my Plan). We're trying an Adderall booster in the early afternoon, but it's proving to be problematic for my sleep if I don't get in some vigorous exercise during the day.  And I do mean "vigorous". It has to be weight training -- going for a run don't cut it.

Back from Family Trip: Thoughts About Memory Loss, ADD, and Blue Light Therapy

A few weeks ago, I wrote about my anxieties about my pending visit to my grandmother.  Some of my anxieties were due to childhood memories of being bored at my grandparents' rural home.  Some of them were due to the fact that my father had told me that she her cognition had "really declined".  Would she even remember that my sister and I were coming in to visit?  Would she recognize us?  Would she be startled every morning to find us there?

The answer to all of these questions was, hell no.  We had a great visit with Grandma.  She has trouble remembering things like what day it is, and therefore what day we were coming, or what time my aunt was going to visit her next.  Her long-term memory, her personality, and -- thank the gods! -- her sense of humor are intact.

Lamictal 200 mgs: Two Weeks, and Still Not Stable

I realized today that it's been awhile since this, my mood diary, has included writings about my actual mood.  Mostly I've been bitching about side effects.  Because they've really sucked.

It's been two weeks since I've titrated up to 200 mgs of lamictal.  My mood was higher, and more even, for the first few days ... and then it rained for a few days.  The days got shorter.  My mood started slipping, and my late-afternoon troughs returned.  I'm still at a point where waking up to a cloudy day, or hearing something that's only a little sad, can leave me depressed for the rest of the day.  I'm seeing my shrink today, and planning to ask him if we can raise my dose.

But.  The last two days have been pretty good.  I think.  Maybe.  Too good?  Maybe.

A few nights ago, I stayed up until 4 am reading Tina Fey's book, Bossypants, after staying up until 2 am watching Voltron.  It was hilarious.  So was Bossypants.

Exploding Head Syndrome: D00d srsly, it's a thing

Last time I visited my pdoc, he was on about cortisol levels as a possible cause of my mood problems.  I'm what's called a "night owl" -- I'm one of those people whose natural circadian rhythm has me falling asleep between 2 or 3 am, and waking up around 10 or 11 am.  Apparently night owls experience some sort of cortisol trough between 4 pm and 8 pm (which is the time my own mood likes to burn down, fall over, and sink into the swamp).  My doctor theorizes that I'm somehow more sensitive to this trough than other people.  Unlike most people, who feel a little sleepy and have a cup of coffee, I spend the hours between 4 pm and 8 pm sobbing my heart out because my cats are going to die someday.

In an effort to be a good, self-educated crazy person, I decided to do some research about cortisol, night owls, and all that jazz.  In the course of this, Wikipedia suggested that a related article concerned Exploding Head Syndrome.  Honestly.  It's a thing.  Not just a metaphor that describes my sinus-and-ear infections, but a thing that's somehow related to night owls and cortisol.  I'm sure it's extremely unpleasant for people who suffer from it, but still ... BWAAAAAAAAAAAAAAAHAHAHAHAHA! Exploding Head!

Lamictal 200 mgs: Day 1

Today is my first day on 200 mgs of lamictal.  I only took it an hour ago, but one thing of note is that I'm already feeling pretty anxious.

Of course, I have external reasons to feel anxious.  My relationship is going through a very rough patch, our first counseling session went very poorly, and I'm honestly afraid to go back.  In addition to that, I'll be visiting my grandmother in a few weeks, and that's bound to be emotionally challenging.  It doesn't help that, since I'm using frequent flyer points to get out there, I have limited availability regarding flight times.  I was supposed to coordinate with my sister about arrival times, but I can't get ahold of her.  I'm afraid that if I wait too long, I won't be able to get the tickets at all, but if I go ahead and book the flights, I'll be inconveniencing everyone by arriving at a weird time.

Hmmm.  Having written that, I think maybe I'm over-thinking this.  Arriving at an inconvenient time would hardly be a disaster.  It's not like I'll miss a wedding or something.

I'm also worried about going crazy again as the days grow ever shorter.

It's not helping that the weather is being damned weird today.  It went from lovely and sunny to dark and raining to lovely and sunny again.  This would be typical weather in the upper Midwest, where I grew up, but for my part of NorCal, it's really not.  I don't know why, but I've always been uneasy when the weather does weird things.  What with climate change and everything, I guess I'll be dealing with a lot of that.

Walgreens: It's Where to Get Decent (Teva) Lamotrigine

As I mentioned here, since I wrote about my experiences with the horrible NorthStar version of lamotrigine (generic lamictal), I've noticed that the top google phrases that lead to my blog are things like "NorthStar lamotrigine" and "NorthStar lamotrigine side effects".

Lamictal is a very unusual drug in that its generic versions can vary widely, not just in the side effects produced, or even in efficacy, but the actual bioavailability of the drug itself.  Officially, some generics only have 80% of the bioavailable medication that brand name Lamictal does.  In fact, the only generic that is identical to brand name Lamictal is produced by the drug company Teva.

Most health plans ding you for buying a brand name drug when a generic is available.  In fact, many will refuse to pay for a brand name drug at all, unless your doctor specifies it on your prescription.  Obviously, then, the thing to do is get your hands on Teva lamotrigine.  But not all pharmacies carry it.  So where do you find it?

Lamictal 150 mgs: The Days Grow Shorter, My Mood Grows Lower, I Break Out the Sun Lamp

After feeling pretty damn good for awhile, mood wise, I think I'm beginning to slip.  I've noticed it over the past couple of days.  I feel slightly depressed throughout the day, even in the morning, and then slump in my usual late-afternoon time slot.

The Fall Equinox doesn't happen officially for another couple of days, but there's been something about the quality of the light recently that tells me it's fall.  The days have grown noticeably shorter.  The shadows have grown noticeably longer.  The angle of the sun is different.

The sad thing is that autumn used to be one of my favorite times of year.  I love it when the leaves change, when the harvest comes in, and when the energy around me speeds up in preparation for winter.  I guess I love seasonal changes in general, which maybe makes California a silly place for me to live.

Anyway, since coming off Zoloft a few years ago, and basically un-sedating myself in the process, autumn brings apprehension.  At the very least, I can expect my concentration to suffer.  Some years it's my mood.  Last year it was my very sanity.

Self-Care For Mood Disorders: Preventing Overwhelm

Whether you have a mood disorder or ADHD, having the support of your family can make all the difference in how well you cope with your disorder.  For me, just knowing the fact that my partner is in the other room helps me to feel stabilized.  Living with another person helps us keep to a regular schedule and feel less isolated.

A few years ago, when I was healthy, I was able to enjoy the times my partner was traveling on business (and these times were many).  I used that time to do my own stuff -- write, work on art projects, etc.  I missed him, sure.  But I was fine when he was around.

This past week was not so easy.  The difficulty was compounded by the fact that my partner and I have been having some fairly serious problems.  Even though we finally had a productive discussion the night before he left, I spent most of the week with feelings of shock, grief, anger, and betrayal.  Until three weeks ago, I thought my marriage was healthy and sound, built on a bedrock of honesty.  Oops.

If my partner had been in town, I would have been reassured by his presence.  We could have continued to talk out our issues.  Instead, he was in another country, in a time zone eight hours ahead of me.  I had to cope by myself, and it was damn hard.  The upside is that I learned some important things about protecting myself from being so overwhelmed that I make bad choices in self care.

Lamictal 150 mgs: My Mood This Week, and Coping with Relationships

My mood this week has been pretty good, considering.  Considering the stress.  Considering the anxiety.  Considering the sadness, anger, and feelings of betrayal.  The lamictal is definitely helping me feel more stable, less depressed, less apocalyptic.

Last week my partner and I finally had a productive discussion about our difficulties.  On the one hand, it was a huge relief to hear why my partner had been so cold and distant the previous few weeks.  On the other hand ... well, on the other hand, it was hard to listen to the hurt he's been holding in.  It was hard for me to learn I'd caused so much of it.  Most of all, it was hard to learn that my partner has spent the last several years violating what I thought was the foundation of our relationship -- honesty.  Our relationship worked because we both valued the truth.  We don't lie to each other, and we don't hide things from each other.  At least, we didn't used to.

After the productive discussion, my partner and I have felt closer than I have for some time.  Unfortunately, we could only enjoy a few hours of this before he left for a ten-day business trip.  The previous few weeks we'd been struggling like hell not to withdraw from each other completely, and suddenly here we were, feeling emotionally close.

Confused?  Hell yes.

Is Your Therapist Really Helping You Treat Your Mood Disorder?

My sister and I have been having an on-going conversation about therapy.  We've both have mood disorders (her's is depression with severe anxiety disorder) and we've both done tons of therapy.  She also works as an administrator of a chemical dependency program, which has given her a lot of insight into the therapeutic process.

Basically, my sister has noticed that there are huge differences between therapy for chemical dependency and traditional therapy..  The crux of the matter is that therapy for chemical dependency is goal-oriented.  The goal is to get you clean and help you stay clean.  Very specific steps are followed in order to help the client meet this goal.

What is the "goal" of therapy for a mood disorder?  How do you know you've met your goal?  What exactly are you doing to achieve this goal?  As a client, it's pretty hard to figure this out.

Sleep, Light, and Mood Disorder

If you have a mood disorder, whether it's bipolar or depression, you have a sleep disorder.  Your body may make you sleep too much or too little.  You may suffer from insomnia or delayed sleep phase, or you may wake up too early in the morning, exhausted but unable to get back to sleep.  Depending on your medication, these symptoms may be exacerbated.

There's been some interesting research done on this, and a fair bit of evidence has piled up to suggest that "blue light" can be a valuable treatment for mood disorders -- but too much blue light, at the wrong time of the day, can really mess us up.  For this reason, mood expert John Phelps, MD recommends that folks with mood disorders turn off their TVs and computers by 10 pm to reset their circadian rhythms.

Why turn off just your TV's  and computers?  Why not turn off all the lights?

Well, most household lightbulbs produce warm, yellowish light.  TV's and computers need to produce white light in order to render color accurately.  White light, as I'm sure you'll remember from high school physics, contains all the colors of the rainbow, including blue.  It's like from this end of the spectrum that tells you whether it's dark outside.  If you surround yourself with blue light, it tells your brain that it's daytime.

In other words, even if you watch TV in the dark, the light from the TV may well keep you awake.  Reading by the light of an incandescent bulb may not.

Lamictal Day 54: 100 mgs. Relationship Stress Decreases, yet Appetite Problems Continue,

For the past ten days, I've been hard pressed to differentiate between loss of appetite due to stress and loss of appetite due to medication.  Learning that your mental illness and learning disabilities are fucking up your marriage can do that to you.

Yesterday I experienced a breakthrough with my relationship drama.  My partner expressed some frustrations he's been withholding from me.  I had the opportunity to express some of my own frustrations.  We got to a place where we agreed that our current patters were royally horked, and came up with some creative solutions to address them.  All in all, we both woke up this morning feeling better about our marriage than we have been in days.

I was expecting that the reduction in stress would mean a reduction in my appetite problems.  But no!

Day 50: My Mood Disorder Action Plan

Tonight is my final MCBT class.  Our homework for this week was to come up with an action plan in the event that, in spite of our best meditative efforts, our depression recurs.  We were told to make a list of our usual depression symptoms (because they're usually the same in each person), write down three things we like about ourselves that we might forget when we become depressed, and create an action plan -- if we become more depressed, what will we do to care for ourselves?

As I've written before, the symptoms I'd long ago learned to identify have changed.

Here are the symptoms I used to have when my depression was getting worse:

• Feeling the edge of The Pit
• Feeling of “falling”
• Feelings of excessive sadness
• Excessive tearfulness
• Irrational guilt
• Catastrophizing thoughts
• Taking things too personally
• Anhedonia
• Lassitude/lack of motivation
• Insomnia
• Overeating
• Oversleeping

And here is what was going on with me last fall and winter:

• Troughs or crashes in mood between the times of 4 and 8 pm become more frequent
• Troughs or crashes in mood between the times of 4 and 8 pm become worse (tearfulness, paranoia about relationships, pessimism running to despair)
• Troughs or crashes in mood lengthen beyond the 4 to 8 pm range
• Tearfulness, sadness, or anxiety due to trivial or nonexistent things (such as cheezy songs, movies, tv)
• Excessively bizarre thoughts or anxieties (such as worrying about the balance or destruction of photons in the universe)
• Feeling the need to act on excessively bizarre thoughts, or take action on the basis of bizarre anxieties (needing to turn all the lights in the house on to keep it "balanced")
• Increased irritability
• Sudden, frenzied activity, especially late at night (such as suddenly feeling the need to clean the house at 11 pm)
• Dramatic upsurge in energy after 10 or 11 pm

Hmmm. Not only are those nothing like my previous symptoms, but they don't look much like depression at all, do they? Good thing I'm seeing my pdoc in two weeks. I will bring this to him and show him it.

For kicks, here's the rest of my Action Plan:

Three Things I Like About Myself (that I tend to forget when I get depressed):

• My sense of humor
• My curiosity
• My creativity

My Action Plan for Mood Symptoms Consists of the Following Steps:

• Breathing Space (use breathing space to check in: would meditation be helpful or harmful at this time?  What is the best self-care I can give myself right now? What steps do I need to take next?)
• Make a choice of what practices are most helpful to me and start using them (be nice to know what these are …)
• Take specific actions, including the following steps:

1. Inform spouse
2. Inform pdoc *** if spouse is traveling, this is Step 1 ***
3. Determine what would be the best action toward self-care and do it immediately

As you can see, my "action plan" is not much of an action plan.  That last one is pretty non-specific, and might not be enough to go on in a crisis.  

Do you have an action plan?  Do you have comments about mine?  Please let me know in the comments!

What the Hell is "Normal"? And Does It Preclude "Greatness"?

If you read John McManamy's blog, you're aware of Nassir Ghaemi's recent book  A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.  You'll also be aware that McManamy thinks it's great, and raises a lot of important issues.  If you read this blog, you'll know that I think the book is highly problematic and not worth my time.

McManamy's belief is that this book starts an important conversation about the "gifts" conferred by mental illness -- gifts that "normal" people don't have.  But what exactly is "normal"?

McManamy makes a passing reference to Nazi Germany, and asks whether "normal" was part of their problem.  As it happens, I've studied this issue in some detail.  Normal ain't got nothing to do with it.  Trauma?  Now, trauma's got everything to do with it.  Is trauma "normal"?  I'd like to think not.  On the other hand, I know plenty of traumatized people, including myself, so maybe it's more "normal" than society would like to think.

But it's important to note here that "normal" may or may not mean "healthy".  When referring to a "normal" organism, the word means that the organism in question is healthy and without pathology.  This is the way the word is used in a discussion about "normal" versus "mentally ill".