Dreamer Easy

I'm reading a saddening but helpful book from 2005, Bipolar Disorder: Your Questions Answered, by Neil Hunt. It's meant for GPs but has plenty of info relevant to patients. It's sad because having an incurable, sometimes fatal illness is sad, and also because so many people (and their families, friends, and doctors) have struggled with this one. I have never forgotten a pamphlet which said "most people with mental illness suffer very much".

Anywho, it's a good refresher on both depression and hypomania (I have Bipolar II Disorder, where you don't get full-blown mania, thank goodness). For example: "... it is unusual to find a depressed patient who is sleeping well." Having trouble getting to sleep, waking frequently during the night, and what I call the "early morning wake-up call", where you wake up at ridiculous o'clock but can't get back to sleep - all too familiar, and compounded in my case by sleep apnoea and medication side-effects. (About a week ago I got so fed up with not sleeping that I reduced my recently increased dose of Epilim back down to 500 mg. Instant and almost total cure - though I'm having to take a little Xanax to get my sleep schedule nailed down again.)

"Depression tends to be the problem that dogs manic depressives in the long term... mild but persistent low mood is the commonest mood state that patients experience, so that on average bipolars can find themselves in a recognisably depressed mood state for a third of the time." This is what my shrink calls "sitting low". I believe my mood stabiliser, Epilim, prevents me from reaching my previous hypomanic highs, which I'd come to accept as a normal part of my life after decades; but I may be wrong about that, and it would be dangerous to stop the Epilim while I'm still taking an antidepressant, as multiple awful episodes of uncontrolled hypomania made all too clear.

Most recently we added Allegron to kill the depression that resulted from the hypomania that resulted from jetlag, but once it had done its job, I came back off it: my liver lacks the enzyme to break it down, so it was building up and up in my blood, making me tireder and tireder, giving me an incredibly dry mouth, and making me have odd, existential thoughts (it can provoke schizophrenia-like symptoms in some people). I'm having a DNA test to check the enzyme thing; I suspect it could explain my history of incapacitating sedation on various antidepressants.

Hunt describes a trap I've let myself fall into: doing nothing but work. "Many people who are depressed have brought their range of activities down to the bare minimum - 'just the grind' - and have stopped doing the things that brought pleasure to their lives." In my case that's reading books and watching movies for no purpose other than enjoyment. (I just read Christopher Isherwood's roman a clef Lions and Shadows for no reason other than that I enjoy his writing, and enjoyed the living hell out of it.) Getting my ass published overseas has become the consuming purpose of my life. It keeps me going when nothing else does, but as this last week showed, it can be a miserable 'grind' when I'm too exhausted or burned-out to attend to it. I need a better balance.

The book also mentions SAD, Seasonal Affective Disorder - depression in winter, mania in spring. I think there may be a little of this in the mix: I associate the change of the seasons, spring and autumn both, with feeling "high". Though I no longer see God when I see bougainvilleas, which is a shame.

Fair bit more of the book still to go.

Reading other people's flaccid SF is always encouraging. Hell, I can do better than that. Or I'll be able to once the Allegron starts working.

Sitting in a Subway deep in the bowels of the Library of Congress and feeling sorry for myself. This was the best food I could locate onsite and the photocopier's out of paper. What's really depressing me, though, is the seven hundred bucks plus I had to shell out this morning for a replacement Byetta pen (one of my diabetes medications). I tried hard to keep the second pen I'd brought safely cold, using a fridge bag and ziploc bags of ice in between hotel rooms (the condensation soaked everything in the carry-on!), but was finally defeated by a malfunctioning fridge in Cornwall. There was no choice but to replace it. We have travel insurance which I pray to heaven will cover it. The cost was bad enough, but more than that, I think what struck me like a truck was the danger that price tag represents, the uncaring coldness, the contempt. This is what Americans, uniquely in the developed world, face as a matter of routine: the knowledge that they are not considered worth keeping alive. My mother-in-law barely batted an eyelash; an epipen for your child will cost you more.

ETA: The heartbreaking A GoFundMe Campaign Is Not Health Insurance (thanks, hnpcc) describes the needless death of an American diabetic who didn't have the money for that month's insulin. It echoes something I was saying to Jon in response to the sticker shock - that this isn't a nation any more. There but for furious protest goes Australia.

Oops! Withdrawal, I guess. Really wasn't expecting that after just one day, and such a small dosage change. Fatigue, racing thoughts, tripping over my tongue, feeling a little spaced out. Keeping an eye on it.

I flew from Sydney to Canberra this week without tranquillisers or panic. Achievement unlocked.

Medical interventions for suicide risk isolating those without mental illness, inquiry hears (SMH, 26 March 2016): perhaps half of the adolescents and adult men who approach Mensline because they are suicidal do not have a mental illness, but are on the autism spectrum and/or have suffered a stressful life event; there's a lack of services for people in those circumstances.

Higher rates of medicine use for mental health problems in remote, disadvantaged areas - ABS study (SMH, 24 March 2016) People in remote areas lack access to psychiatry and psychology; disadvantaged people can't afford them. (A reminder of just how lucky I am. It ain't cheap.)

Now, I tut at the SMH using an emotive term like "ripped" to describe the loss of $57 billion from the federal health budget in 2014. Newspapers, as I am always saying, should not be in the business of telling me how to think or feel. This, however, is not a newspaper, but a mere blog. $57 billion?! Forgive my Easter Saturday blasphemy, but Christ on a bicycle --! Perhaps because of my good luck, I had forgotten just how deeply the current government had assaulted Australians' lives and health. No wonder some public hospitals are simply disintegrating. (The Healthy Kids Check was scrapped last year; the free clinic for the homeless in Sydney will close soon. And there's a plan to make things even worse here by offshoring medical treatment. The links I've accumulated on the impact of the budget on Australians' health just go on and on.)

Meanwhile in rural and remote NSW, the life expectancy is about the same as that in North Korea, with a lack of healthcare resources partly to blame. Disadvantaged areas in Sydney are facing a diabetes epidemic.

Indigenous suicide rate 12th highest in the world (SMH, 10 July 2015)

Two thirds of Indigenous people dying before age 65, AIHW report finds (ABC, 9 June 2015)

Ugh, that's enough for now. I really hope this turns out to be the election issue.

I've switched from insulin to exenatide*, which is more complicated to take, but comes with the huge bonus of decreasing my appetite instead of increasing it. I'm not experiencing nausea, which is a common side effect; I'm eating slightly less at mealtimes and barely snacking at all, which is a major change.

I am concerned the stuff might be giving me a low mood, but as usual there are so many things that could be making me feel down that it's difficult to know which to blame. Bipolar? Sleep deprivation? Menstruation? Actual emotions? Who knows.

* Brand name: Byetta. Made from the saliva of the gila monster, one of the only two known venomous lizards. No joke.

Rx, bloods*, B12 shot, BP, oil and grease change.

* "That's very nearly an armful." "It's 16 mL!"

Surprise depression attack. (Well, maybe not surprise. But sudden as heck. I'd forgotten what it even felt like.)

Some years ago I was standing jetlagged in a Maryland CVS when I had the fleeting but powerful impression that someone was about to walk up behind me and shoot me in the back of the head.

I tell you this bizarre anecdote to try to convey the depths of my travel anxiety. This is not "have I packed enough books for the flight?!" stuff. For over a decade, I've been arriving in the US with a combination of sleep deprivation, jetlag, and untreated (or worse, incorrectly treated) Bipolar II Disorder.

The flights themselves provoked panic anxiety disorder - not just on the day, but for weeks before - but at least that could be somewhat controlled with tranquillisers and cognitive behavioural therapy. The rest was madness: irritability, withdrawal, and anxiety, including and the sort of weird paranoid feelings that I experienced in that chemist's.

Last year's trip was a noticeable improvement: with the correct diagnosis at last, I was on a mood stabiliser (Epilim) and had something (Zyprexa) to correct the jetlag which can set the bipolar brain see-sawing. Further tweaks to my medication (I'm now on 60 mg Cyprexa and 1500 mg Epilim) mean my Bipolar II is now even better controlled, so I am hopeful for this year's jaunt.

Where I'm not so sure, however, is on the anxiety front - particularly my social anxiety disorder, which contributed earlier this year to my freaking out at the last minute and missing Conflux. An OS trip also always means a convention. I am not a gregarious person by nature. A con is a nauseous mixture of somewhere I don't want to be with somewhere I am still fairly conspicuous. On the whole, I'd rather have a nice cup of tea.

None of this is anyone else's fault. Our family are unfailingly welcoming and generous and I've never had a bad experience at a con (except that one awful panel, but that was my own fault. :) It's so unfair that, instead of being an untarnished privilege and pleasure, our annual trips Up Over have also been the source of so much dread and pain.