Sunday, December 28, 2008

"Best of": Avoiding a Depressive Crash

From 6/27/07:

I had planned upon our return from the trip to LA to have refills of my most needed medications in the mail from Canada, namely my antidepressant, Cymbalta, and my pain medication, Celebrex. To my horror and surprise, neither had arrived, only an old telephone message that both had been "back-ordered" from Europe. "Both?" I said, calling back. "Solly, one wasn't weady yet and dey don't like to ship dem together." Cheap bastards, I thought. I urged them to get them to me ASAP, whereupon the Indian pharmacist said: "Den you would accept generic?" Of course, you bubble-headed booby! I thought.

I try to keep such thoughts to myself today, because uttering them doesn't help anyone. In private with Kathleen these past two-and-a-half weeks on the road, I have often sat in a motel bed and said, "I hate everyone! I hope they all die!

"Bite your tongue and ask for forgiveness," she would say, especially if I mentioned a family member by name. So I would do what she asked, but the prayer always sounded disrespectful with the lisping effect of teeth on tongue. Nevertheless I did comfort myself with the knowledge that all would die, if not soon enough to suit me.

Why these near nightly rages on the road, I don't know; they were not manic, just a feeling of general anger towards everything, cheap motels, fast food, ungrateful children and obtuse others, all the while suffering pain, emotional and physical, while on limited means on what seemed an interminable road trip to Long Beach, CA, even if no major snafus occurred.

I wouldn't have missed my baby's graduation, but I wouldn't do it again, either.

I think my anger may have been warning me about my grief, particularly over the fortunes of my eldest daughter of late, whose care on the trip exhausted me. But I'll keep her secrets for now, even if she is fond of broadcasting them. Every time I think I have come to accept her as she is, she finds some new hot buttons to push. She's gifted that way. Yes, she's the redhead in the picture at the top right of the blog.

Back to the meds. When I had no Cymbalta for two days I sank into a depressive episode, weeping for half an hour, struggling not to let any verbal equivalents enter my brain, as in "You're worthless. You suck. You've never done anything. You despise your own children." No, I didn't let the lies of the frontal cortex insinuate themselves into the vortex of my lizard brain, thus was proud I could recognize my depressive seizure as just that, an uncontrollable outpouring of emotion unrelated to any specific thing. I also had the wherewithal to call my doctor for a short-term supply until the cheaper meds from Canada arrive; I got these yesterday afternoon and then proceeded to twitch so badly I had to sleep apart from my wife. This is an early side effect of some antidepressants, but thank God, it means they are starting to work.

I sometimes think that part of manic-depression is a complete disconnect, in time, between the emotions one should naturally experience and a safe time to let them out. So, for example, I could go tight-lipped through a funeral and weep at a video arcade a month later. Once I even thought I had come closer to better integrating my emotions with regard to circumstances, but I fear for us bipolars this is a chimera. It's as if we build up mountains of rage and dig chasms of grief of which we are consciously unaware, and one day we smack into them and all hell breaks loose. Chemically, from the standpoint of the actual illness, this likely holds little scientific truth, but it is a useful metaphor for conceptualizing how the phenomenon sometimes feels. In the end manic-depression is really just bad genes and bad luck.

Now it wasn't entirely my fault that I was out of meds, but first a cautionary note: if you respond to an antidepressant and go off of it, your chances of responding to it a second time are much reduced. Since Cymbalta was the only thing I responded to after a year's misery, even missing one day was inexcusable. But that's all I missed. So whoever reads this post, remember to take your medications faithfully, especially if you suffer a mood disorder.

Next post:

I obtained on Tuesday, through tearful anxious phone calls, a refill on my antidepressant, Cymbalta. The substitution of Prozac for two days wasn't cutting it; I switched back to my shrink's recommended dose of Cymbalta, twice normal, of 120 mg. Tuesday afternoon.

Soon after I began to experience akisthesia, a peculiar symptom where you can't become comfortable, where your body must constantly move, twitch--where there is a supreme discomfort in stillness and you must keep moving--your feet, your legs, something. You can't watch TV or read; you can't concentrate; mostly you indulge in various irresistible writhings. Naturally this physical phenomenon drives Kathleen crazy in bed so I had to sleep downstairs. But I knew it was a sign that the antidepressant was working again, or about to work, unlike the thousands of psychiatrists who hear this symptom from their patients and think it means they can't tolerate the medication. I find this "ants in the pants" feeling in my body almost always precedes an improvement in my mood, and have observed the same in countless patients.

Although not confident Wednesday, I didn't cry. And Thursday I worked out for hours at the gym. Today I was afflicted with a little melancholy but managed to get a lot of work done despite it.

So, gentle readers, I didn't mean to leave you hanging on my decompensation--I'm doing better. The downside is that the damn Cymbalta capsules, of which I need two a day, cost about $5 apiece here until the discounted meds arrive from Canada. That's an expensive habit, especially when you combine it with Lamictal, of which I must take two a day, when each tablet costs $4, even at Costco. Until the patents expire on new medicines you need, you're truly fucked without insurance, and as I have previously blogged, I can't obtain insurance, medical or life, because I am a bipolar: bad risk).

The pharmaceutical companies have a limited window to recover their R & D money, and I don't see them as villains, more occasional saviors who must recoup R & D costs on all the drugs that didn't work from ones that do. Accusing them of malfeasance is like attacking "big oil"--wrong target. I'm no Republican; it's just so easy to blame the nearest elephant. The reality is much more complicated.

I've added another paying poetry publication to Byline and and Contrary now; I just got a check from Valerie Polichar's Grasslimb for "The Gloaming." Since I quit writing poetry and started marketing it, I'm not doing half bad.

Even more amazing, an original copy of my first and only book of poems, Elementary, which sold as a paperback at $14.95 in 1997, is listed by one seller at for $398. My eldest daughter told me this but I couldn't believe it. Go figure. Did the rumor of my death exaggerate the price? There are likely book speculators out there, some who are betting that I might be important someday. Or maybe it's just a fluke. Curioser and curioser. (I've never received a single royalty payment from the book.)

This fact gives me hope that the same concern, Mellen Press, might consider publishing a second book of mine. No, I checked that out; like most smart publishers they don't do poetry anymore. .

In the spirit of marketing, I'll close with a poem I wrote before I was an ex-poet:

Homo Promo

You who huddle under billboards
happy in your anonymity,
grateful to avoid the rain,
how I pity you!

You should be up there
above the freeway
in a red bikini
with a high-end tequila
in your happy fist.
Don’t you get it?

Become a commodity
hawking you 24 hours a day:
be your own infomercial!
Celebrity is the only currency
and the Dow is measured in air time!

The first human infomercial was Muhammad Ali,
who became the most recognizable man on the globe.

To become your own spin doctor,

1) Wrap yourself up so tightly nothing hurts.

2) Like Rome, let every conversation lead to you.

3) Although you were never loved the way you wanted to be loved,
there's always a chance if you please your audience!

4) Always sell the product.

5) You are the product.

If Marx and Nietszche could see us now
united in the strife which divided us
at once worker and robber baron
it's hard to find good help anymore
no longer alienated from the product
nobody told me there'd be days like these
I'd love to see the look on their bearded faces.

Wish me luck as I perform solo at the Lavender Festival tomorrow. I hope the wine tasting goes quickly to loosen up my audience; I'm no James Taylor or Cat Stevens, that's for sure. But I do alright.

Thine at 1 kilorat,


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