Going off the drugs…

There are some things it’s really hard to be open about in a public forum, and mental illness is certainly near the top of my list.  While I have zero shame or trouble regaling people with stories about things like sex, mental illness is a chink in my self-esteem’s armor.  I’m frightened to talk about parenting with a mental illness because someone might say that people who have mental illness shouldn’t have kids…and that will wound me deeply because deep down, I sometimes worry that it’s true (or at least is true in my case).

But at this point, it’s just too much work to allude to medications and depression, so I’ll come out.  About a year ago I was diagnosed as being bi-polar type 2 (a milder form of bi-polar disorder), after years of being depressed and trying anti-depressants that while taking an edge off, never really seemed to help.  The lithium seemed to help, at least a little.  But given the stress of R’s joblessness, my psychiatrist moving 7 weeks before we did (to somewhere else in the US), and then the overwhelming move…it didn’t seem to be helping much anymore.  And, as with every time I’ve been on anti-depressants, my writing and my creative outlets became blocked, causing me to lose one of the parts of myself I value most.

Moving to Singapore created big problems.  Firstly, there are issues surrounding Dr / patient confidentiality, and if the government wants your records they can get them without anyone telling you anything about it.  I don’t think it’s paranoid to say that knowing that makes me nervous about seeing a psychiatrist here.  Secondly, there are MAJOR cultural barriers–I’m bisexual, I have fairly liberal attitudes about a LOT of things, and I am very much a Massachusetts Liberal in almost every sense of the word.  I worried that finding a therapist here would create problems…and I was right.  I found myself editing to the point where talk therapy is useless here because I’m too busy filtering and hiding details that I worry might create problems for me here.  Finally, the drugs are in different dosages here and we had to adjust down my medication…to a point where it seemed to be helping even less.

Lithium is a drug that is deadly to pregnancy.  To the point that any woman on this drug should wait three months after going off it to ensure that it has completely left her system and will not endanger the life of a wanted child.  So the game plan was for me to start weaning off of it December and to stop it completely on March 1 (although my research says this would have been useless, as anything lower than a therapeutic dose would have been taking unnecessary medication and that as Lithium is not addictive, it can be safely ramped down in a matter of days) for a projected “start trying” in June of 2011.  I would have to be off of it for the entire pregnancy, and any time that I spend breastfeeding (which, with any luck this time will be a year, barring food allergies on the baby’s part).

I actually had to stop taking it cold turkey about a month ago because when I started an antibiotic for the swimmers ear, some weird drug interaction happened and I puked every time I had taken both drugs within a 12 hour period.  So I just stopped taking the Lithium and it got better (side note, this interaction has happened before, so I didn’t consult anyone this time).

Then I just never took it again.

At the end of the day, the meds were a no-win situation.  Not taking them has pros and cons, but so does taking them.  When I don’t take them, I’m far more easily agitated (not great with a two year old testing boundaries all the time), I have to deal with depressive bouts, but I can write, which is a non-drug-related release and natural high for me, and I laugh far more easily and feel joy.  When I do take them, I have to deal with a medical system I don’t trust, I’m calmer but I’m numb–I don’t feel the depressive lows but I also lose my joy, in some ways I’m a better mom (I’m more patient) but in others I don’t know that I’m better (I don’t easily get silly and play with her with the ease I can when I’m non medicated).  The sleep issues do not seem to be affected one way or the other by medicine…I’ve had trouble with sleep most of my adult life.

In this instance, it was a case of when, not if going of the drugs was going to happen, and recently we’ve been talking about moving up #2 (although not by a lot), so being off them is probably a good thing in the immediate run.  But once I’ve weaned #2, I do need to figure out how to treat this illness in a way that benefits myself and my family.

I’m trying to find an American therapist who can do Skype (although I’m not looking as hard as I should be, if I’m being honest here), to handle the talk therapy between now and then.  I’ll make a point of getting serious about it when we’re back from our trip home, as I know pregnancy is going to be full of triggers for me, and now that this whole #2 thing in Singapore thing is looking really really real, I can’t let myself think about delivery too carefully because with everything that happened with E (if you don’t know, read the archives for November and early December 2008) the idea of delivering a child is a bit of a trauma trigger for me as well (one of the many reasons I’m strongly considering a scheduled C, and am going to try to meet with my American OB while home to see if she has a good reason not to, all things considered).  I’m an idiot if I don’t think I’ll need emotional support from a professional during that time.  But I’m also an idiot if I think I’m going to find the right supports in the Singapore mental health system.

The deepest truth though, and the one that’s hardest to admit is that deep down, I don’t want to need drugs to feel “normal.”  I want to be able to handle my life (even though it can be hard) without the pill.  I also know if it were someone else, I’d encourage them to take the medicine and that there is no shame in needing it to correct a chemical imbalance (which bi-polar is).  On the other hand, I can’t lie to say I find it shameful that I may need to.  That I want to say I survived 30 years without it, and that I should be able to continue on without it as well.  But that ignores the fact that my life is profoundly different than it was 10 years ago when a deep depression meant it was okay to hide in my room for a few days until it passed.  I have a child who needs me.  If I’m not around because I’m working, then fine.  But if I’m not around because I’m in a deep low and medicine might shorten the length of the low or prevent it entirely…is that okay?  Even if taking the meds means I feel very little?

I just don’t know what the right long term solution is.

But for now, I think being off the meds and making my body the best environment possible for #2 is the right move.  Whether I start trying in January or March or June.

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