Abilify, Not I : Adventures in Antipsychotics

Lately, I have written a series of posts over the last two months describing certain troublesome symptoms I associated with the worsening of Bipolar Disorder, or the potential for comorbid disorders.

In my last post, When Medications Go Wrong, I briefly wrote about my recent discontiuation of the pharmocological treatment using Abilify as part of my medication regimen:

Recently, I stopped my Abilify.  Admittedly, it was because I noticed an interaction between the Abilify and my weekend consumption of alcohol.  I started to find that I would fall asleep soon after taking it on Friday’s while we drank.  I decided that I would just stop over the weekend, and continue during the weekdays as normal.  But, eventually, I just forgot to take it at all.  And soon, I started to notice an improvement in my worsening condition.

I went on to describe some of the awful side effects I was experiencing as a result.  However, the list was truncated for the sake of keeping word count down.  The description is rather limited in terms of accurately depicting exactly what I was subject to.

• Cognition Disturbances and Memory Fragmenting.  Originally, I wrongfully blamed Lamictal in Vitamin L : Medication Adventures for my aphasia-like symptoms.  The disturbances felt like aphasia.  At first, it was almost indescernable.  I started word dropping again, meaning I would be reaching for a word, but was unable to grasp it.  Instead, I would be able to get to every synonym around it, however, those words did not fit the exact context.  Eventually, it became a more severe form of word dropping, and I found myself dropping sentences entirely at the loss of any word or synonyms around it.  It progressed into entirely dropping conversations at the loss of a sentence.  Then, I found myself

  I started forgetting things again.  These were simple things, like losing my purse or shoes in the house.  It seemed like just a simple case of forgetfulness, maybe stress related.

• Emotional Blunting and Partial Flattening.  I had never had too much trouble with emotional blunting in the past.  While I’ve found myself in times where it was difficult to express my emotions, this didn’t indicate a lack of emotional response.  I describe it as a partial emotional flattening, because it wasn’t an entire lack of reactivity.  It felt like my spectrum of emotions had been significantly reduced, although not completely removed.  There was a certain inaccessibility to certain strong emotions.  Rather than completely removing extreme emotions, it threw a wet blanket on top of them, leaving them to bubble under the surface.  So, the emotions still existed, but were muted and unable to be adequately expressed.

  At it’s worst, I began to lose most feeling entirely, with the exception of irritation and the sensation of boredom and fatigue.  I began to lose love and my attachments to meaningful people and my relationships with them.

• Dissociation.  I touched on a summary of the dissociative symptoms that Abilify had brought on.  I have been writing articles on the experience throughout the last few months on the subject, describing the feeling in great detail, but remained unable to exactly identify is appropriately.  The dissociation probably occurred as a response to the prior bullet points.

  The dissociation cited was experienced as a removal of self and removal from my own life.  I had felt as if I had been separated from myself and my world.  It was a feeling of something being stolen from me, or something fundamentally inaccessible.  Like, I was being locked out of my own life, or becoming transparent and just fading away.

• Worsening of Depressive States.   This is probably a direct result of the first three bullet points.  I started to disengage from my life.  I lost interest in just about everything.  Most things were considered to be either boring or tedious.  Important things started to lose meaning.  This was experienced as a part of the emotional flattening, but it caused a concerning and distressful reaction.
• Exacerbation of Social Anxiety.  Since I had lost the ability to carry on a conversation and found myself completely disinterested in socialization, my social anxiety went through the roof.  I simply didn’t care about anything anymore, especially trivial things I used to find interest in.  Therefore, I found it difficult to carry on a conversation.  This caused extreme distress in social situations, and encouraged further isolation.
• Disturbed Sugar Levels.  While I have no concrete proof in terms of tests, certain symptoms have come to my attention.  They are notated below in the next two bullet points as thirst and weight gain.
• Loss of Sensation of Bodily Hunger, Thirst, and Fullness.  Within the last few years, I started to become more in tune with my body.  I was able to feel the sensations of hunger through my sugar level, which probably caused the loss of bodily hunger.  The disturbed sugar levels probably also caused an extreme thirst that could not be quenched.  At first, I craved water.  Eventually, I started to put the soda back down, which probably caused part of the weight gain mentioned below.  And I felt an extreme pressure in my stomach, which was also exacerbated by the influx of so much fluid.
• Extreme Weight Gain.  Truthfully, I don’t dare get on a scale at the moment, so I am unable to notate at this time exactly how much weight I’ve gained.  By the fit of my clothing, I will estimate that I have gained somewhere between ten and fifteen pounds in the last three months.  That is a substantial gain for me, especially since I was losing weight prior to the start of this medication.
• Exacerbation of Eating Related Problems.  By all definitions, it’s completely possible that I am living with an undiagnosed eating disorder.  However, I am not entirely convinced, since it isn’t an ongoing and prevalent problem.  Therefore, I define it as eating related problems and difficulties.

  The concern for weight gain and the sensation of fullness caused a very terrible reaction of binging and purging.  I was unable to control my eating, as notated above, therefore the sensation of extreme fullness would cause me to perceive the overeating as worse than it actually was.  Unfortunately, this led to a very vicious cycle and encouraged further weight gain.

• Disturbed REM Sleep.  I was waking up tired, and noticed that it felt like I had stopped dreaming.  This caused my mental state to take a considerable dive.  It caused extreme fatigue and excessive, unproductive sleeping.

While I am cleared of most dissociative symptoms, emotional flattening, and my depressive state is lifting a little, some side effects have remained.

• Cognitive Disturbances.   The aphasia-like symptoms remain, but to a lesser degree.  I am back to just being a little forgetful, and have some minor word dropping.
• Memory Fragmenting.   Some of my memories remain dull, but seem to be returning.  However, most of the last three months remains inaccessible.  It may never become accessible, due to the disruption in the formation of short-term memory.
• Disturbed Sugar Levels.   I am still thirsty, but I am no longer engaging in carbohydrate seeking consumption behavior.  I figure it will take awhile before my sugar is regulated properly again.
• Weight.   Thankfully, my weight does seem to be coming down.  I have only been completely off of the medication for less than a week, and my clothes are already fitting better.  I’m going to assume that in addition to the weight gain, I was retaining water and constipation.  My regularity has come back, and I don’t feel as puffy as I did

Unfortunately, I am experiencing a return of some of my milder psychotic symptoms.  In Imaginary Enemies, I described a cognitive disturbance I described as “The Voice”.  “The Voice” can be characterized as a singular persona, as I wrote about in Conscious, Subconscious, and Extraconscious, where I described a theory of a third consciousness that exists between the subconscious and the conscious mind.

The Extraconscious is postulated as where the persona(s) reside, laying in semi-dormant waiting, perfectly aware of the current reality that is being experienced.  “The Voice”, in more severe psychotic states, can be experienced as a separate entity entirely, detached from the consciousness.  That is the defining line between a cognitive distortion and an auditory hallucination, when a persona detaches itself from the extraconscious as an external sensation.

As an extraconscious persona, “The Voice” can best be defined as a quasipersona, lying somewhere between Dissociative Identity Disorder and psychosis.  It is experienced as a semi-active part of the conscious mind, as the dominant persona is well aware of it’s existence and there is a certain interaction that occurs between the dominant persona and “The Voice”.

That is the best theory I can offer as to the existence and function of the quasipersona, known to me as “The Voice”.

The mild auditory hallucinations and visual hallucinations have returned, probably defined better as a sensory disturbance, rather than a symptom of psychosis.  When experiencing a sensory disturbance, it’s not full on hallucinations as described in the definition of psychosis.  There are not entities separate from the body.  They are recognized as a disturbance in the current reality, distorting shapes, colors, and contrast in the vision.  In the hearing, it is experienced as a distortion in sound, causing sounds to be sharper, duller, muffled, or louder than they actually are.  It can only be sensed by a sudden shift in perception.

So, instead of hearing things at a normal sound level, the sound volume may increase to deafening levels or may become muted and difficult to discern from nonexistent static that occurs in the mind.  My visual disturbances may be perceived as viewing the world in high contrast, extremely bright colors, and / or extra high definition resolution.  Or, they may be seen as duller than usual, muting colors, distorting shapes, and / or clouding the vision with that appearance of a veil or foggy goggles.

Intrusive thoughts have returned, but not with the same extreme nature as experienced several months ago.  In truth, they were never completely removed by the Abilify, and at some points were made worse by the drug.  Instead of experiencing them as a truth in reality, I am now able to separate them using logic.  I can talk myself off of the ledge and separate them from the reality of a situation using DBT techniques of mindfulness and distress tolerance.  Prior to the cessation of Abilify, I was unable to utilize those techniques.

I don’t mean to put anybody off of treatment with psychiatric medications, but I felt this was important to document and have as a resource on the internet for anyone who is thinking about taking the drug.  Some of these side effects aren’t listed in the pamphlet, as they are probably isolated to a condition.  But, I feel they are still a distinct possibility for anyone who is being treated for similar conditions.  It is vital that this information be notated and readily available for medication education purposes.  This information probably should not be generalized to all psychiatric medications, especially in the class of antipsychotics.

 

Ethereal Shadows

Anxiety runs rampantly, off of it’s leash, and unchecked.  It envelops me, trapping me in this fully contained, semi-translucent bubble.  The oxygen runs thin and the overabundance of carbon dioxide fogs my mind.  I am suffocating and immobilized, encased in thick, unyielding plastic.  I can see the world through clouded lenses all around me, but I am unable to touch it, to reach it.

The thoughts race faster than the stock cars in my mind, polluting my air within the dome.  “What if…?”  “How can I possibly…?”  “What can’t I…?”  My confidence dissolves in the thick, poisonous soup it creates.  I begin to disappear, becoming thinner within the wash.

And eventually, the cars come to a grinding halt, gears moaning and crunching at the sudden termination of everything and anything.  For a moment, the entire world, the whole existence goes blank, as plain as a clean sheet of paper.  Then, suddenly, I am propelled into pitch darkness, fumbling around for the scattered remnants that are not my own cognition.

In this blackness, there is a certain emptiness abound.  A void of mind and feeling transforms me into an ethereal creature containing the absence of any trace of matter.  I drift aimlessly upon streams of thin air, shivering as currents pass clean through me.

My soul liquifies and pours like a thick, black ribbon into a clear mason jar.  Now, it is preserved like blackberry jam, shifting and wiggling with its gelatinous quality.  My hands caress the glass longingly, for it has become as unreal as I have become.  I may look upon it, however, I may not touch.  It is now a forbidden fruit that will spoil long before I am prepared to reclaim it as my own.

Abysmal sheets of icy rain obscure my vision now.  A thick fog rolls in as dense, leaf bare woods encompass me.  Severed from me, my own emotions are carried back in with the fog, high above my head as it rolls on.  I reach, stretching my entire being high in the air above my head, attempting to get just a little bit closer toward them.  But they are not my own.

Are they?

Indistinguishable.  Everything becomes questionable in this parareality.  Wispy words come out in airless breaths within this vacuum of time and space.  Questions come rolling into reality with no discernable answer.  “Where am I?”  “Who am I?”  “What am I?”  All concepts float away, vibrating with each anxious blink.

Each push of the fog shoves me flat on my back against a frozen, unforgiving, unyielding earth.  Each successive tumble knocks even more wind from my lungs.  I squeeze my eyes shut and resign myself to this fate.  Paralyzed, I am defeated against this awesome force.

Everything is (not) Wonderful Now

“I just don’t understand how you can smile with all those tears in your eyes and tell me everything is wonderful now.” – Everclear – Wonderful

I feel as if I have been robbed of something.  Most of the time, I’m blank with these vague floating emotions.  Sometimes, I can tap into them, but it is more akin to breaking open the Pandora’s box.  These emotions suddenly intensify and flood over me, consuming me like a tsunami.  A thief crept in the window to my mind and stole my translator for emotion to cognition.

I am inclined to speculate as to whether this is just a side effect of losing those internal monologues / dialogues.  On occasion, I catch myself attempting to recreate them, especially in the moments of severe, agonizing distress.  However, there seems to have been some kind of role reversal.  Instead of my dominant persona being confused by multiple personas in my head, those lesser personas being the ones who generated the intrusive thoughts and discord in the chambers of my mind, there remains one persona.  This persona is new.  She’s the therapist.  What do people call it?  Maybe the voice of reason?

Blank slate.  I am seemingly an empty canvas.  I never cared much for empty things, because they require filling.  There are always these second thoughts and doubts; Am I doing it right?  What if I mess up?  It highlights the cracks.  I float around in my life without immediate purpose, without the constant noise that colored my life.

One would think the riddance of such garbage background noise and a wide spectrum of ever fluctuating emotions would be a positive improvement.  There remains this empty container where thoughts and emotion would overflow out of, the tap of which being always open.  The source has dried up, and it seems an IOU is tightly fastened to the bottom without a named perpetrator.

One would suspect that another would be at peace without such distressful experiences such as psychosis.  Instead, I find that I cannot seem to associate myself with this state.  I don’t belong here.  This doesn’t feel right. Something is wrong.  It’s all wrong.

One would think that all of this freedom would be so wonderful.

Everything is not wonderful now.  The tears of mourning still come to my eyes as if I were somehow missing a piece.  Colors seem to be dimmer and the whole world feels washed out.  It is distressing in itself.  The absence of myself.  The crazy, emotional, outrageous, always interesting, talkative woman has become muted, grasping at straws for conversation and content.

Is this what it feels like to be normal?

The Seeds of Doubt

Amnesiac.

That might be a painfully accurate depiction of a large part of me. My memories prior to eleven are largely fragmented, save for a few vague impressions, recurring themes, and a traumatic experience that has recently resurfaced to rear it’s ugly head at me. Regardless of how often I attempted recalls, those calls went unanswered. A flicker, like a spark, would come alive, but leave existence as quickly as it came.

I often find myself in a unfocused world of disjointed memories and alternate realities. The vast fields of fog are sewn with seeds of doubt, spouting fears and obsessions. In those fields and shadows, monsters have plentiful cover to prowl for their prey – me.

They often say that when a lie is repeated so many times, it starts to embed itself as a portion of factual memory. Basically, if a person believes in something strongly enough, it becomes real. It becomes enough to rewrite someone’s entire history. The lines between reality and fantasy start to blur in a place where fiction and fact can coexist, even potentially peacefully.

Unfortunately, I have not once before been a person who can successfully smudge the details of my own personal past. Not to myself, anyway. I can report being guilty of deception by omission. But, something distressful stirs and blinks with any instance I even remotely consider telling a blatant lie.

This is not say I am immune to deception and coercion into accepting an outright lie. My psyche is malleable in the way where I am susceptible to manipulation. Why? Because it’s been the very basis of which I have been raised.  My father once told me, “Believe none of what you hear, and only half of what you see.”  Then, was it his intent to distort my world in such a way that I will one day have difficulty trusting myself?

There are so many clinical words for this.  Dissociation.  Depersonalization.  Derealization.  Psychosis.  Delusion.  Hallucination.  Dissociative Fugue.  Splitting.  Repression.  Coping.  So many clinical terms that overlap in their definitions, and yet, not one quite captures the true essence of being within it’s grip.

For me, my repression has a proximity sensor.  Clinically, it’s called Dissociative Amnesia or Dissociative Fugue.  In the past, I have always called it throwing a block or throwing up a wall.  I am figuratively walking along in my own mind, through wild, overgrown fields and forests of my own memories to suddenly smash into a concrete wall.  Suddenly, the whole landscape shifts, and I am boxed in this nondescript, blank white room.  White walls, white floors, no windows.  It is me and a dining room chair.  This is my mental waiting room, where I am being isolated until the memory of the memory passes.

I call it, “The Eraser”.  When it’s all said and done, I come back to consciousness in my own familiar surroundings, in my own waking life.  But, is it?

This is the direct result of the seeds of doubt being sewn into a person so carelessly in the impressionable youthful brain.  The concept of an active consciousness is disturbed, and the development is stunted and contorted.  It must be so easy to manipulate someone with such a frail sense of reality, a blank canvas of self, and stunted emotional maturity.  And that’s why abusers do it.

I slip in and out of streams of consciousness, alternate, yet simultaneous realities, and find skips and pauses that disarrange an incomplete chronology of life.  I start to get the belief that I am, in fact, a time traveler, as my external self as my own ship, however I have no use of my own controls.  Somehow, somewhere along the way, I have been damaged.  It mimics human ailments.

But I know none of that is true.  I am just as human as the next person, with cognitive dysfunctions resulting from mental illness and latent trauma.

Or faulty wiring.

I doubt everything.  My experiences often seem surreal.  My memories, unless attached to a particularly powerful moment, are vague.  My short term memory is shot, so it becomes unreliable.  I doubt everything I feel, all of the conclusions that I come to, and some of what is right in front of my face.  I doubt right down to self.  Is this me?  Am I me?  Am I here?
How did I get to such a place where I have to question everything?