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 GainTruthfully, 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.

 

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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.  DissociationDepersonalizationDerealization.  Psychosis.  Delusion.  HallucinationDissociative 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?

 

Antipsychosis

I find that I’m sifting through every corner and combing every shelf.  Typically, this is how the search for my marbles goes.  I have a bulging pouch, a testament to my . . . (I cannot find the word.  This is aphasia at it’s finest.)  To my bounty of sanity that I contain.  No, instead, I am frantically . . . hunting for my inspiration.

Is this dry spell the direct result of my lack of “a certain something”?  Certainly.  Am I what I would consider sane and stable?  Certainly not.  I am muted and docile.  No gusto.  No fire.

No original thoughts of my own, apparently.

There is a certain amount of pressure mounting the a point of bursting.  Unfortunately, I cannot seem to even see my own hand in front of my face.  That is how lacking in vision and perspective I am.  I am unaware if this . . . tension is a dam walling the roaring waters of content.  Silently, I pray it is.

Instead, I feel this tightness in my psyche so strongly it becomes somatic.  What lies beneath, within?  What could possibly be of such importance that it has created a friction that produces no heat?  In all honesty, what could I possibly say about anything?  There is a complete absence of thought.  It has all become a runny stew, too brothy to hold the meat and potatoes intact.

Brain Goop Soup.

. . .

And more nothingness.  Annoyingly silent, echos of almost, faintly mocking me in nondescript whispers.

. . .

I suppose that sometimes, a disconnect develops.  This disconnect . . . well, it is just as indescribable and inexplicable as the nonsense prior.  I find the disjointed nature of these thoughts to be the severing of one underdeveloped conscious thought to the next.  Reality has become too real, and I have become evicted from my own headspace.  Expelled into the real world, where time is near frozen.  Days are detached entities, and moments have no . . . a lack of continuity.

I have found that this is the polar opposite of psychosis.  This is the state of antipsychosis, where reality is overly dominant, and abstract thought . . . is a concept in which I have to make a concerted effort.  Never before in my life have I been so uninspired, so dried up.  My home was in my head, a comfy nest in which I resided.  Where do I make a home in reality?

My bullshit radar is going off.

I find the discovery that instead of tapping into something original, I am going through the motions.

I am needy.

Extroversion has become a monster that requires feeding.  I cannot find the willpower to stop myself from desperately searching outside myself for intellectual stimulation, self-affirmation, and creativity.  I do so with the intent to stir my own soup, but I instead crumple that little page of notebook in my mind and immediately discard.  Irrelevant, my brain determines.  It does not sustain my basic needs.  It is superfluous.

Just pet me and tell me that I’m wonderful.

Not because I need the validation.  I have enough evidence to convince myself of that truth.  (Mania, maybe?)  It just feels nice to be acknowledged in the real world.  Because in the real world, I feel as if I am a wandering, translucent ghost.  Are you listening?  Can you see me?  Do my words count for anything?

Is there something wrong?

Is the theory of antipsychosis actually a manifestation of psychosis?  Are my ideas of eviction from my brain, but an absence of presence in reality a problem?  It is not distressing.  Okay, I find a tiny drop of distress, only at the idea that I may never have another unique idea again.  That this blankness, this . . . blockage will be my doomed fate.

Is my intense desire to be thought of actually neediness?  It is a tad distressing.  It is watered down.  I can live with it.  I find extreme boredom in everything.  Worse, I find myself to be the most boring of all.  I have not once before experience such severe boredom.

How do I reach out and make a connection when I have nothing funny, witty, inspiring, or provocative to say?

 

My Super Powers

Bipolar disorder has a way of distorting perceptions that color the world in the mood of the moment.  It might be an inconvenient truth during most times, but in mania, I can say that I sometimes find it truly fun and interesting.

 

Mania is like a teen girl that preys on my unstable sense of self and often convinces me that those half-truths are a strong reality.  In dysphoric mania or, as some clinicians think, a mixed state, those whispers can come in the form of intrusive thoughts.  However, in hypomania and euphoric mania, they come in sweet whispers of steroids for self-esteem.  They term that “delusions of grandeur”.

 

I feel like that might be an overkill kind of term for what I typically experience in milder manias, or even hypomanias.  Typically, I have enough litigation between my id and ego to come to some kind of realistic compromise between the two competing truths in my mind – “I am not particularly special,” and “I am completely unique.”  That’s just a stock version of the battle that rages in there sometimes.

 

I am led to believe that everyone has a special ability, kind of like a super power but without the super part.  However, that might just be the fluttering eye lashes and sincerity in the voice of that lovely young miss who smiles sweetly at me.   But, seriously, everyone has a unique ability that only a small population might possess.

 

Perhaps a person was born with it.  For me, the sixth sense is my unnatural empathy.  I can literally feel emotional vibrations from others.  I have termed this ability the state of being an “Empath”, after the Star Trek race of half-Betazoids.  Of course, once I Googled that term, it seems I’m not the only one that came up with that, and it’s unlikely that they derived it from the same origin.  Others might be able to accurately predict weather with the (super) power to sense slight variations in temperature, barometric pressure, and humidity.  I find that I can only smell rain and feel the magnetic field shift ever so slightly.  Some might even be clairvoyant or even psychic.  That is one (super) power I can honestly say that I have never thought to possess.

 

Others might be able to develop it.  Personally, I developed the skill to see lies.  Thanks to the show Lie to Me, based on the work of Paul Ekman, I practiced the art of recognizing and reading microexpressions.  In addition, I studied Psychology in college with an emphasis in Applied Behavioral Analysis.  In essence, I’m a behaviorist.  All of those combined allow me to see right through a person.  An ill delivered phrase, combined with a microexpression opposing their forced expression, and the nature state of being an Empath, deliver all I need to know about a person.  Unfortunately, it’s most effective when I’m having face time.  That is why I have a certain preference.

In addition, I developed the skill of deciphering a natal astrology chart.  All I need to know are the positions of the planets when a person was born, and I can translate that into a full personality workup.  I have the ability to tell people things about themselves that they were unaware even existed until they do a bit of introspection.  I’ll do my own short version workup for a bit of proof.

Ascendant:  Sagittarius

I like to appear put together and in control.  I may have ego issues and I take criticism very personally.  I am likely to be passive-aggressive with acquaintances and have a tendency to shoot verbal arrows in the attempt to start an argument.

Midheaven:  Virgo

I have a need to look unassuming.  I want to appear practical, methodical, and quiet.  To acquaintances, I seem shy and set about my business.  I want to keep things clean and orderly.  I am the least likely to initiate confrontation, and I attempt to dodge blame whenever possible.  Owning up to my superficial mistakes is difficult.

Moon:  Libra

Life has to be a beautiful experience.  I am prone to surrounding myself with beautiful objects and people.  Drama-prone, difficult, close-minded people are not welcome, because they do not promote harmonious friendships.  However, there is a strong need for partnerships, romantic and otherwise.  I have always had a lifetime goal of finding “The One”.

I am often free with my emotions and I feel strongly.  However, I am always concerned with a balance of emotions and equality in relationships.  Flaws present easily, and I am always prone to attempt to “fix” things, and especially people.

Sun:  Capricorn

It is in my nature to be overly ambitious and practical.  However, I am not too practical to the point of extreme sacrifice.  I have a taste for finer things, but am less likely to indulge, though it will likely happen.  I like worldly goods, and might have a tendency toward hoarding.

I feel as if I need to be useful and purposeful in my life.  My life has to make a difference in others, and tangible results are the only way for me to feel successful.

I have trust issues, especially after betrayals.  I have difficulty letting things go.

Mercury:  Capricorn

All communication is practical and purposeful.  Information that does not serve a purpose cannot be compartmentalized or connected to anything useful is often discarded without thinking.  I am always eager to go after independent study, and get defensive when someone attempts to teach me something in a domain I was sure that I was highly skilled in.

Venus:  Pisces

I have a warm heart and a soft spot for people in need, making me naturally good with children and animals.  I am naturally sensitive and am high maintenance in a relationship.  I can be a bit selfish in my friendships and romance.  I often trust my heart in relationships rather than being practical about it.  I have a need for dreamy moments and have a tendency toward idealizing people and situations.

Mars:  Pisces

I don’t like to fight.  I avoid confrontation.  If confrontation happens, though, I can have a bad temper.  Sometimes, it is irrational anger and misdirected.  I am prone to feelings of shame and guilt.  I have difficulty regulating emotions and maintaining relationships as a result.  I want everything to be perfect, simple, and nice.  I want all of my relationships to have a dream-like, supernaturally close kind of quality to them.

I have a tendency toward manipulation, though I am not apt to actually want to hurt anyone.  However, I have a strong sense of want, and can be kind of selfish.  I am never really sure what I want, and I shift constantly between extremes.

Jupiter:  Capricorn

I have to work for good fortune.  It doesn’t just come to me.  However, with time and effort, I can usually see good results.  I have high integrity.  I am ethical and professional.  In addition, I am urged to be responsible and organized.  I am at my happiest when my world is neat and orderly and trouble free.

However, I am easily annoyed by little misfortunes and mishaps that could have been avoided.

Saturn:  Scorpio

I am generally secretive, and not always purposefully.  I am not always straightforward, and I feel a need to have a rich internal life that I can reside in at will.  I do not lend my trust easily, and I do not forgive easily when someone has burned me.

I have a need to control my life and situations around me.  When this is not possible, I am prone to retreating into that internal world where I rule.  Unfortunately, that means retreating from the external world.

I do not like failure, and I will run from it every single time.  That is usually how many of my projects go unfinished, because I was overly ambitious and ran at the hint of failure.

 

I will be happy to do anyone’s full natal chart if they are interested.  Just email me at lulu.em.stark@gmail.com.

 

So, I’ve divulged all of my (super) powers.  They might be delusions, but they are mine.  What are your powers?