Back when I was a public defender, I represented people being committed for involuntary psychiatric treatment. I used to get kind of annoyed with the bipolar people, because the story was always the same. The person took medication, felt better, decided they no longer needed their medication, went off of it, and then when off the deep end. I used to ask myself, “Why can’t they just stay on their medication? HOW HARD IS IT?”
When I found myself diagnosed with Bipolar Disorder Type 2, therefore, I believed strongly in the importance of medication. I also thought that treatment would be easy. All I needed to do was take some pills, and I’d be totally normal, right? Three years after diagnosis, I still believe in the benefits of medication, but my opinions are much more tempered by experience.
By the time I was diagnosed, I was pretty hypomanic. My brain was not at all working properly and I knew it. I began a very commonly prescribed mood stabilizer, but one which causes a potentially very dangerous rash in a small percentage of people. Guess who got the rash? I did. So, I had to stop taking that medication.
A month later, my doctor prescribed a second medication. This medication can cause a dangerous lowering of sodium levels (called hyponatremia), so I started getting blood tests to monitor my sodium level. Eight months later, my husband and son and I went to Kauai for vacation. The night we arrived, I felt incredibly disoriented and dizzy. We went to the emergency room, where it was discovered that I had a sodium level of 123. A normal level is 135-145. Anything below 120 and I could have slipped into a coma. So, we spent our first night of vacation in the E.R. with me getting an I/V of sodium fluid.
After the experience in Kauai, my doctor and I realized we needed to constantly monitor and manage my sodium levels. I take EIGHT salt pills a day to replace the sodium that my medication flushes out of my system. My husband makes fun of me because I carry around a little pill divider in my purse LIKE I’M EIGHTY. I get a blood test every two to three weeks to make sure my blood sodium level is safe and I have to constantly monitor my fluid intake. It turns out I’m also sort of a water addict, so I have to make sure I’m not drinking too much, because that can lower my blood sodium level. That’s right, I have a drinking problem because I drink too much water.
So with this sodium issue, why not just take a different medication? The problem is that every medication has side effects. Some cause changes in metabolism, which can increase the risk of diabetes. Some are extremely hard on the kidneys. No medication is perfect, so I take the one with the least adverse affects.
Despite dealing with the side effects, taking medication is still worth it for me. The medication I take really helps me. I don’t have the dramatic swings in energy that I used to deal with on a regular basis. I miss the productivity of being a little bit manic, but my life demands that I be stable and productive every day. I haven’t been severely depressed since I started medication, which is pretty great. I still have some days when I feel extremely productive, and I still have days when I just want to lie in bed and eat cookies, but my mood changes are more within the normal range.
Maybe someday I won’t need medication, but that day is not today. Maybe I will take medication for the rest of my life. Who knows. Either way, I’m okay with it. I’m committed to taking things one day at a time, in consultation with my doctor.
Because of my experience, I’ve also been dissuaded of the delusion that medication would “cure” me. Thankfully, bipolar disorder is a very manageable illness, but it doesn’t manage itself. Medication only does about 30% of the job. Therapy, regular sleep, a good diet, exercise, and stress management are all things I must focus on to be healthy and stable. I work every day to take charge of my life, rather than letting my moods take charge of me.
I really miss being a lawyer and some day I hope to work with the mentally ill population again. In the meantime, though, my own experiences give me a lot more compassion for other people dealing with mental illness. I occasionally help to facilitate a mental health support group, and I’m a lot more patient now when people vent about the challenges of finding the right medication or dealing with side effects. I will never again wonder, “How hard is it?!”, because I know that it can actually be very hard.
My experiences have also motivated me to become involved in mental health advocacy. I recently agreed to serve on the board of my local NAMI chapter, which is my first quasi-professional activity in years and which I am extremely excited about. Access to great psychiatric care is just one of the things I’m passionate about. I’m lucky to have access to a great doctor, and not everybody does.
We don’t choose our battles in life, but we can learn from them. Hopefully others can learn a little bit from my experiences, too.