January 28, 2009

Life is a Riddle in a Maze

Life is a riddle in a maze, and not just my life. If you think it's not, just look at the absurdly complex financial Rubix Cube that America has just handed to President Barack Obama, saying, 'The nigger will NEVER figure this out," or "Let the smart nigger have a try!" Oh, well, maybe that's not what everyone was saying to themselves, but Barack Obama is a Black man with a Rubix Cube in his hand and some part of four years to show that it can be solved. Except this particular Rubix Cube has sixteen or thirty-two separate and sometimes vaguely similar colors on each side.

Does it seem like I'm exaggerating. Maybe I am, and maybe Obama's chances to resolve the nation's financial troubles are better than my chances to resolve my emotional and existential questions.

Today, I was in a psychologist's office, begging him for a prescription for Zoloft, which he couldn't provide because he is not a psychiatrist or even a doctor. Like the nurses, he urged me to return next week to schedule an appointment with one of the above. I fidget, looking for some document in my pants pockets, which the doctor found very interesting. I realized that he was sizing me up and perhaps feeling pity for my condition.

I suspect he was feeling pity because I was searching for documents that would also be available to him in the medical records at the clinic, which he had undoubtedly already read. It was what I now perceive to be a desperate and misguided and futile attempt to convince someone who couldn't and wouldn't do anything for me in any case this morning. And so I was a patient in desperate need of medical care, who wouldn't get any this day.

Actually, I did get some medical care. I thought I had a parasite growing in my foot (I know this sounds like a symptom of schizophrenia, but it's actually quite common in this part of the tropics), and yet the nurses were not able to find evidence of a parasite. What they found was a little piece of red something that one nurse extracted from my foot with a needle. I urged her to dig further into my flesh, looking for a parasite, but assured me there was none. I believed the nurse, too, could see what I was feeling (panic), but she didn't say she could.

I was afraid I would say something that would compel them to hospitalize me, and then there was no telling when or how I might get out. I was afraid I would tell them that I was considering cutting my head off with a chain saw, while also thinking of first killing my dog, hanging her from the ceiling, and disecting her in search of something interesting. There has to be something interesting somewhere in my life.

My mental experience "like a rollercoaster", feeling enthusiastic and purposeful for a few days, and then confused, morose, and hopeless for a few days, without any obvious reason for the changes from the one state to the other.

For two months, I went without access to my checking account and could barely buy food. So, it was natural for me to explain my sadness, depression, anxiety and frustration to others in terms of my financial situation.

Now, I have access to my funds and to all of the money that has accumulated over the last two months, while I was unable to spend any of it on intelligent or silly purchases. I am "rolling in dough" and don't feel any better than I sometimes did when I couldn't pay my rent.

My dreams disturb me, and my mind disturbs my dreams. I dreamed that my electricity bill was six times higher than it had been the month before, and that left me panicking about getting value for my money and being able to afford to live.

I feel cheated on my rent, since moisture is coming through the ceiling in ever more places, leaving my space dank and moldy. I want to pay less, but I am afraid to start a dispute with my landlord that would result in me losing and having to move out of a place that I need, even when it is imperfect. And so I feel confused and ambivalent, procrastinating for a week about paying the rent, even after having the landlord's forbearance for the two months during which I had no access to my money. I confuse myself. I don't know when to feel grateful and when to feel resentful. I feel both at once and then I am paralyzed, like a rodent by a snake bite, now being eaten alive by my own confusion.

January 27, 2009

Prozac Helped Me Resist Compulsions

I've taken fluoxetine, otherwise known as Prozac. One of the most notable effects of it was that I was more able to resist compulsive behaviors, like sex addiction, when taking Prozac. I had less compulsions and the urges I did have were more easily resisted, so I felt less like I was under attack from my own desires and compulsions.

I would really recommend looking at anti-depressives like Prozac for people who are alcoholic, sex-addicted, obsessive-compulsive, OCD, Borderline Personality Disorder and other disorders in which feeling generally lousy leads to counterproductive behavior.

I remember feeling very surprised that many people in Twelve Step programs suffered feeling lousy AND having constant compulsions without looking at anti-depressives.

I remember a guy who was on anti-seizure medication. I told him that seemed silly to me, since he had never had a seizure. (This was before the Internet allowed members of the public like me to easily access drug information and understand why drugs are prescribed.) But, anti-seizure medication can work as a mood stabilizer. Now, I take it. This is really humbling, to remember all of the times when lack of information and lack of humility caused me to offer bad opinions to others and to lead my own life based on lack of information or misinformation.

January 26, 2009

Two Simultaneous Affairs?

Tonight, after a meal of spaghetti bolognaise with cut corn, my friend and I began discussing my dog and women (or the lack of the latter). I confided that I had recently begun encouraging my dog to sleep in my bed with me.

My friend asked if I was having an affair with my dog.

I said, "I'm having TWO affairs with her! One in her asshole and another in her pussy!"

And then I began laughing uncontainably, wickedly, as if the devil himself had indwelled my funnybone.

My friend asked me again if I was having an affair with my dog. I said, 'Asked and answered!'

As if often the case, he didn't know whether to believe me or not, since I had just told him that I was going to begin practicing gynecology. He urged that I would need to go to school for that, but I retorted that I could learn all I needed to know in three days on the Internet.

I have often thought of opening an emergency care clinic in my home. I would simply put out a sign saying emergency care and turn my livingroom into a waiting room. When family members brought a desperately sick relative in for diagnosis and treatment, I would aske them to wait in the waiting room while the sick came to my "operating room." Then, I'd take a sledgehammer and whack the sick person over the head six or seven times, as the case required. When, after hours, the family finally asked urgently how their relative was doing, I would emerge from my operating room covered in blood (and some gore) and sadly announce, 'He didn't survive. That's the tough part about medicine: Sometimes what seems like a bad head cold can turn into a much worse head trauma.'

Maybe it would be better to be a gynecologist, using the most sensitive exploration tools that a man has to offer.

Oh, I'm terribly sorry! Have I failed to offend some of my readers? Come back tomorrow. Blogging is a progressive illness.

January 15, 2009

Clonazepam (Clopam) Overdose

Since I don't drink alcohol, clonazepine overdose is basically a non-issue. Althhough I am supposed to take 2 mg before sleeping (or else I might never sleep), tonight I took ten milligrams before sleeping, in the hopes of sleeping longer and more soundly. The main noticeable side effect is walking with more torpor, nearly bumping into wall and falling overrr things before righting my direction. (If I drove a car, this might be a problem, but since I long-since gave up doing so, lack of motor coordination when I am asleep is a nonissue.)

Were I to do this regularly then a higher tolerance for the drug and a psychological dependence would also be concerns. But I only do it when I feel extremely frustrated and would prefer to poison myself, if possible. This happens to me once every four to eight months, in my experience. After taking five times the regular dosage at midnight and falling asleep within twenty minutes while reading the newspaper in bed, my dog awakens me at 4:30 in the morning and I am obliged to attend to her, just as if I had taken no medication at all.

A symptom of my mood, perhaps, is that I am letting my dog out by herself, even in a town that is unforgiving for unchained, unmuzzled dogs, because I just don't have the energy or inclination to follow er and wait for her to pee and shit. She much prefers to be let loose to follow her own instincts late at night, which lead her to take long sniffing walks and to come home when she gets tired or thirsty.

Clonazepam is a good alternative to spending the night awake, which eventually leads to decreased mental faculties, shorter patience, an enhanced sence of psycological fragility, and finally insane(r) decision-making, otherwise known as "decompensation".

Five hundred percent larger doses of Clonazepam lead only to torpor and eventual dependence if repeated often enough.

I've never tried compounding these dosages with massive quantities of high proof alcohol. I stopped drinking alcohol because if I wasn't going to kill myself outright, I didn't want the many side-effects that alcohol causes, like loss of social control, violent and belligerent behavior, forgetfulness to the point of absolute blackouts in which one can remember nothing, lying, stealing,and becoming completely unreliable. Massive doses of alcohol can be part of a well-planned suicide plan, when combined with an "antiemetic", "A drug that prevents or reduces nausea and vomiting." The body wants to rid itself of alcohol, which is essentially a poison, but cannot do so because of the effects of the antiemetic, which is available at pharmacies without prescription.
Exit Association-Mediated Suicide: Toxicologic and Forensic Aspects.


American Journal of Forensic Medicine & Pathology. 20(1):40-44, March 1999.
Giroud, C. Ph.D.; Augsburger, M. B.Sc.; Horisberger, B. M.D.; Lucchini, P. M.D.; Rivier, L. M.D.; Mangin, P. M.D., Ph.D.

The Swiss German chapter of the Exit Association provides conditional assistance to individuals wishing to end their own lives. The Exit Association advocates death with dignity and fights for the right to freely choose the timing of one's own death. According to the Swiss criminal code (articles 114 and 115), altruistic assistance to suicide is not punishable. Active euthanasia is punished by imprisonment. An individual commits active euthanasia if he or she is driven by honorable motives (e.g., pity) and causes the death of another person wishing to die who seriously and insistently requests such action. Based on our information, the preparation for suicide and its completion relies on a well-defined protocol. First, the candidate's eligibility for Exit Association assistance is verified. The candidate then writes a farewell declaration that explicitly confirms the will to terminate his or her own life. A written report describes the events during the suicide procedure. Depending on the circumstances, the investigative judge requests a forensic autopsy and toxicologic analyses. The results of the forensic investigations conducted in the cases presented here are in agreement with the scenario described in the reports of the Exit Association, namely, suicide by massive ingestion of pentobarbital. American Journal of Forensic Medicine: Exit Association-Mediated Suicide: Toxicologic and Forensic Aspects.

A husband present at a Dignitas assisted suicide describes the process and the role of antiemetics:

Eventually we managed to get some morphine linctus and ampoules of diamorphine. . . . It was reputed to be enough to kill a horse. We were given some water and though we all had a drink, the real reason was to check that Elizabeth could swallow the necessary volume of liquid. It was explained that she would have to take an anti-emetic half an hour before she took the drug, and repeated, several times, that she could change her mind at any time, up to the point where she took the final glass.

She drank the anti-emetic, and we sat there chatting. . . . hich amazed me.

Finally he said to her, "Are you ready?" . . . "If you drink this, you will die." It was her final chance to change her mind. And she said, "That's all right. I'll take it."

It's very bitter stuff, apparently, but she started to drink it quite successfully . . . I think she had taken perhaps three-quarters of it, and we were frightened that she wouldn't drink enough to kill herself before she passed out. But eventually she began to black out, and it stopped her coughing. She had drunk about nine-tenths of it. And within perhaps 50 seconds of first drinking it she had gone to sleep. And that was it.

He waited about half an hour after she had drunk it to make sure that she was dead.
In our church choir, at the African Methodist Episcopal Church in Central Square, we used to sing the following verses:
I feel like going on.
I feel like going on!
Oh, oh, oh, problems at every hand!
I feel like going on!
So what, exactly, were we singing about? We used to sing.
If anybody ask me
Where am going?
Where an I going, soon?
Just say, "I'm going over yonder!
I'm going over yonder!
I'm going over yonder, to be with my Lord!
Again, what were we singing about. We never discussed it, perhaps because it seemed obvious to most people, perhaps because we were afraid, and maybe because it was just compelling music whose content we ignored.

I Am Disgusted With Tegretol

A week or two ago, I began taking 150 mg of Tegretol, increasing the dosage from 50 mg, in the hopes that my moods would stop swinging like a pendulum. At first, I thought the drug was having the desired effect, but now I suspect that I was merely on an upswing at the time that I began taking the drug.

Let me tell you something, if you are considering suicide, based on no personal experience. If you really want to drug yourself to death, you're going to need a medication that doesn't mix with alcohol, some strong alcohol in lethal doses, and an anti-emetic, so that you don't barf up all that you have taken, which would be the normal course of events. I once bought half a gallon of whiskey with the intention of following through with this, but I lacked the courage or determination, or something. That was fifteen years ago, and I'm still alive because I have taken no definitive and affirmative action to die.

Massive quantities of drugs and alcohol taken together have been known to kill quite a number of famous actors and musicians:
death followed a night of hard partying that had involved beer, champagne, barbiturates, cocaine and finally morphine. This combination caused his throat muscles to constrict severely and he suffocated throughout the course of the night. Wikipedia: Tommy Bolin
Driving a car eighty miles an hour with one's eyes closed doesn't count, nor does driving eighty miles per hour on black-iced roads. Those are merely games, which kill some, leave some crippled, and are unreliable methods. The fact remains that the most lethal suicide methods are firearms and suffocation (hanging), in that order. A Brown University study found:
From January 1990 to December 1997, among individuals 10 years or older in the state of Illinois, there were 37 352 hospital admissions for para-suicide and 10 287 completed suicides. Firearms are the most lethal suicide method. Episodes involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those involving suffocation—the second most lethal suicide method. Preventing access to firearms can reduce the proportion of fatal firearms related suicides by 32% among minors, and 6.5% among adults. Lethality of firearms relative to other suicide methods: a population based study.
A friend who may be required to carry a gun asked me if I would be comfortable with a gun in the house. I didn't respond because I think I might be happy with a gun in the house, knowing that the experience that I so dislike so much of the time could be over in the pull of a trigger. Parents should keep guns in the house, the bigger the better, otherwise their children may have no means to kill themselves when the need arises.

Calling the Samaritans

My psychologist ordered me to stop writing in this journal, and I did for a while. But I have moved away from the town where I saw her and the primal instinct to write (communicate) reasserts itself. Even if I am only communicating with myself.

I think constantly about death, which is why I started this journal in the first place. When I was between the ages of 18 and 1991, I used to call the Samaritans nightly, because I was afraid that my depression (depressive thoughts?) would overwhelm me and I wouldn't be able or willing to make it to work the following day.

In addition, I desperately needed someone to talk with openly about my suicidal thoughts, without fear that they would call the police or a hospital. (If I told them that I had acted on my thoughts or imminently would, they would have called the police or a hospital.)

I did get some relief from those calls, sharing my deepest insecurities and worries. Once, I even found a girlfriend by calling a Samaritan-like group. The more I told the woman on the other end of the line about myself, the more she told me I deserved a hug, a kiss . . . some physical intimacy. I challenged her to make good on her observation and she did, in my bed, over and over again, throughout a period of months.

It wasn't the worse that could happen. I only regret that she smoked and her mouth tasted like an ashtray. But she was a good and loyal friend - the one who first observed that I was not really capable of taking care of myself, judging by my physical environment. She was prescient.

Today, I would not call the Samaritans, because . . . I am not interested in perpetuating my life. I would not call the Samaritans because I've been there and done that, literally hundreds of times. I would not call the Samaritans because the valuable solutions they propose are ones that I have tried, over and over again.

Maybe I should call the Samaritans, instead of asking my barber to slit my throat with a his straight razor, and telling my closest friends about my fantasy plan to cut off my head with a gas-fired chainsaw.

I've tried taking a bunch of pills, but it only led to short hospital stays that solved nothing at all. Today, sometimes I fill my mouth with pills simply out of frustration, but I know they will have barely more effect than the normal prescribed dosage. For those who really want to die, I recommend reading "Final Exit" by Derek Humphrey, because the book provides a recipe for a drug cocktail known to be lethal. The Assisted Suicide Blog quotes Derek Humphrey as saying in that book,

‘Knowing how to die well not only makes life more enjoyable but ensures that it is more endurable towards the inevitable end.’

There's something philosophical and practical that I'd like to say about suicide, based on four decades of experience: It is not enough to not want to be alive, e.g., 'I don't want to live.' In order to die, one must take affirmative steps to stop the life that lives in one's body. Otherwise that life will live on virtually endlessly. It is not enough to not want to live, or to "wish" one were dead, because wishes have no effect on the physical world unless they are acted upon.

To die, one must take affirmative and effective steps, such as hanging oneself when there is no one around to intervene, or shooting oneself in the head while sitting on a pier, where one will die of drowning if not of the gunshot alone. "If wishes were horses then beggars would ride." Wishes cannot kill someone. Only action can.

January 13, 2009

Oh, What a Mess!

Well, now I've done it! I've slept until every conceivable store and restaurant that would accept a credit or debit card is closed, and I have nothing whatsoever to eat. I might have bought something earlier but what little money is in my checking account is borrowed, to prevent my checks from bouncing. It would make little sense now to spend that money on food, only to see my checks bounce later.

My head hurts a little bit, either from hunger, tiredness, or physical exhaustion, having walked to every restaurant with a quarter mile to see if they would accept a debit card. None of them do.

To avoid robberies and kidnappings, Bank of Brazil "twenty-four hour tellers" are open for withdrawals only until ten o'clock at night. Get your money early or don't get it at all.

I could have eaten at my friend's house, particularly having supplied that house with food for precisely that purpose, using checks payable thirty days from now. But, I was asleep when they were eating and now I am hungry when they are sleeping.

I don't seem to be doing very well at getting my basic needs met.

Sometimes I reflect on friends that I had when I participated in various "programs", only to remember that that was sixteen years ago. I am not so loyal as to remember friends sixteen years after I last spoke with them. I am unwillingly loyal to the desire to kill myself that I feel when I reflect on our conversations and interactions.

I have gotten somewhat better at maintaining friendships over the last five years, and so I am less likely to feel intense self-loathing when I think of these friends, with whom I am still in friendly contact. My sibling closest in age is an exception. I don't speak with him. I'm free and I'm proud.

Sometimes, the idea of eating my dog occurs to me. I'm sure I would regret it afterward, but it would kill the hunger right now. I could drive a steel bar through her from one end to the other and then attach welding electrodes to each end of the steel bar, roasting her from the inside out. I've never tried that before, and it probably wouldn't work.

I am trying to call my wife, fruitlessly so far, or rather to signal her to get on MSN, without paying for a long-distance phone call to her cellphone. As far as I can see, I basically have two choices this evening: wait until daybreak and spend money I don't have on food, or hang myself and thereby avoid all additional (and past) expenses. Tired as I am, if I just get in the bed I am likely to sleep for hours and hours. Of course, I still won't have any money when I wake up. But I could buy some food at the supermarket with a check for sixty days out.

What silliness obsessing over eating! I can simply fast until my financial situation improves, resolving the problem of hunger by making a resolute decision not to eat, just as the alcoholic resolves his obsession with drinking by making a resolute decision to refrain and simply not entertain the idea of drinking at all.

Now, my eyes are closed and m head is rolling around on my neck. This might be a good time to sleep, if I had any sense.

My friends here are Catholics. They believe in God. I hate God if God exists at all. There is simply no heavenly excuse for the operation of nature or for the interactions between man and man, and between members of other animal species. The laws of nature require that most of us animals (and even plants) eat or be eaten. That fluffy bunny rabbit has to give himself eventually to the fox, and the fox to the dog. It's God's plan.

It must also be God's plan that humans eat each other, metaphorically mostly, and so I have no use for "God." The value of God requires that we give him credit for all that is good and attribute all that is bad to our own failings, or aspects of nature that God cannot or will not control. Typhoon in India? It's God's will. White fosphorous raining down on Gaza? That, too, is part of God's perfect plan.

Well, excuse me, but God can go fuck himself.

January 11, 2009

All Dressed Up and No Place to Go

This evening, as I looked out my front door and saw Brazilians young and old walking purposefully toward the downtown area, my curiosity was piqued. Where are all of these people going, while I am homebound, writing in my journal and reading news about human-made catastrophes thousands of miles away?

So, I took a shower put of some of my most chic plaid denim shorts, and some other new clothes from my favorite department store, and I set out to follow the crowd, like one follows the curiosity seekers toward a fire.

Although the mass exodus had stopped by the time I was outside, I walked in the same general direction and found restaurant bars full of people eating and drinking beer and soda, and talking. For the most part, they were couples and families, although I had seen many younger and unaccompanied people during the earlier exodus. The people I saw were eating pizza and pasta, crepes and hamburgers at various venues. Apparently, this is how many people spend Sunday night in this Brazilian city.

Silvio Rodriguez wrote these lyrics:

"Tu me recuerdas el mundo de un adolescente
un seminiño asustado mirando a la gente"

Translated: You remind me of the world of an adolescent:
Part-child, shocked as he looks at world.

There are basic aspects of human behavior that to me are only barely comprehensible, or less accessible than a U-turn on the New Jersey Turnpike. What people do on Sunday night, and why and how they enjoy it fits into that category of the only barely comprehensible.

And yet, I reflect on my weekly meetings with my friends at Primo's Bar and Restaurant in Porto Seguro, where we ate barbecued beef and chicken, sipped soda and chatted about all sorts of things, and I know I have had the experience that these people in this little town are engaging in. I just don't have anyone with whom to engage yet.

Returning from downtown, I went to a bar twenty yards from my house and sipped a coke with lime and ice. Many of the people I had seen there last night were there again tonight, in groups, in couples, and some alone and apparently lonely. I was not interacting with them, but merely observing them, like an adolescent trying to figure out what's going on. Most adolescents intuitively understand much better than I do.

Walking there, I was cheered by a Meatloaf song of which I only remember the following lyrics:

But every Saturday Night,
I felt the fever grow.
Do you know what it's like?
All revved up and no place to go?
Do you know what it's like?
All revved up and no place to go!

Now that I read the lyrics for the first time, I realize they are about sexual hunger rather than a mere lack of social outlet on Saturday night, if there is any difference between the two.

Even with Clopam

It's 7:38 P.M. and I basically haven't experienced this day at all because I stayed up all night last night. I just awoke because my dog insisted on taking shit. Otherwise, I would have slept the day away entirely, at the risk of then being awake during the night.

As I took the dog for her walk, I remembered the talk therapy I engaged in in 1986-2001. Yes, I overcame my fear of women during that period, graduated from college magna cum laude and entered law school with a full scholarship. But, I was experiencing mood swings that no one could explain to me. I cried daily and mourned for months, rooting around in my past for the basis of this mourning, without suspecting that it might simply have been my genetic makep.

I experienced daily attacks of rage that I tried to "vent" "appropriately", by beating a garbage can in a secluded area. But, I eventually beat all of my furniture, including my microwave oven, with an ax. I was trying desperately to act behaviorally "normal" even as my brain chemistry blew up repeatedly like a pressure cooker with a bad gasket.

Eventually, I "came on" to a woman who was a deeply good and intimate friend of mine but with no desire to engage with me romantically. When she didn't respond, I lost all interest in returning some of her favorite CD's to her, and I couldn't see that this behavior was problematic until the intercession of another close woman friend with whom I had a similar experience later.

"Julie" asked me if there wasn't something seriously wrong with me that Christmas, when she saw that I had rammed my Christmas tree through a closed window with the lights still flashing. (I know this wasn't original behavior. I had read about it in a recovery book and it seemed like a good idea.) "Julie" was perhaps shocked, terrified, and afraid for me.

I still cannot say that I fully or even partially understand that period, except to note that all of my success with my "issues" and academically and professionally left me with a big hole in my chest that nothing could fill. Even when I had a girlfriend who loved and doted on me, I cheated on her relentlessly, inviting another woman to the theatre with us, watching the show with one woman on each side. I knew my behavior was unconventional, but then my life has been relentlessly unconventional and promises to me more so in the future.

During that self-help college days period, I refused to take any medication at all, fearing that I might "stuff" or "medicate away" my feelings, or "bury my anger alive." In any case, medication hadn't seemed to improve the lives of the family members I knew. It just made them admittedly insane and chemically dependent.

It might have been the manic depressive episodes of my older brother that convinced me that some people simply need to take medication whether they like it or not - but not me, because I had the courage to "deal with my feelings". Meanwhile, my ever-changing and unpredictable chemistry was "dealing with me" on a daily basis.

When I started law school, my behavior became more clearly manic. I chased after and "sexed" three women and more women simultaneously; dressed to impress like a cock showing his colors, even when I couldn't afford it and when it would not help me to pass my first-year law classes or the Bar Exam. And, that Christmas, I bought expensive sweaters for all of my friends, who had already tired of the increasingly extreme inappropriateness of my various behaviors. My expensive presents were received like gifts of sugar candy during a typhoon of my own making.

Is it one's own fault when one is "insane" and behaves terribly? I used to believe that "placing blame" was useless, and yet the responsibility for fixing the behavior and its consequences lay with the sick person. Now, I understand that sometimes the responsibility for improving the behavior of the sick person lays in significant measure with the medication that the sick person takes. Even the refusal to take medication can be lain at the foot of the mental illness from which the person suffers, as in manic depression.

During my first year in law school, as I cried on the floors of my friends' houses with no relief in sight, I became so painfully insane that I welcomed ANY medication that would help me to feel better and meet my responsibilities without making my situation worse.

I had some brief interactions with the police during these periods, which I dealt with well, aside from the fact that my insane behavior had caused the interactions in the first place. I once was driving on a small street in Providence, Rhode Island, passing every car in spite of the traffic light at which we all would stop in moments. When I reached the traffic light and stopped, I saw the unmarked police car lights whirling in the car directly behind me - the one I had just passed and cut off.

The officer asked me what my problem was. Assuming correctly that my emotional turmoil was visible in my face, I simply looked contritely at the police officer and didn't say anything at all. In fact, had I known what my problem was, I probably would have sought treatment for it rather than behaving in that way. The officer perceived my extremesis and simply told me to drive more slowly, which saved him the trouble of checking me into a mental hospital.

The exact same thing happened again within weeks on another intersecting street in Providence, Rhode Island. Because I didn't drink or use drugs, and I knew I was behaving erratically, I wasn't belligerent or incoherent, which probably saved me many beatings and arrests.

Staying Up All Night is Fruitless

As so often is the case with "all-nighters", my efforts to invent a muzzle for my dog, using steel and a soldering machine, were entirely fruitless. But I cannot blame myself for my effort being unsuccessful, since I have purchased several muzzles in dog stores and my dog has torn every one of them to shreds or removed them from her head as if she were Houdini.

The dysfunctional aspect of my behavior was in seeing my efforts as something worth losing sleep over, knowing all the while that failing to sleep at night leaves me depressed, irritable and unstable, as well as unable to participate in the following day. I took the medicine that is supposed to oblige me to sleep, but the manic determination to finish this project was stronger than the medicine.

Finally, the muzzle I created does not muzzle the dog, is too heavy to be useful, looks like a tool of torture designed by the insane and for the insane. In fact, its crudeness reminds me of meal dispensing machine that my older manic brother made two decades ago in an attempt to limit the food he would eat. The machine was made of steel and each meal was in a compartment with a little padlock to which only my brother would have they key! The idea is not so much more insane than those little pill holders that help pill-takers to separate their medication into the days when it should be taken, also helping us to remember if we have taken our medication or not.

My brother's metal food dispenser did not help him to lose weight, and my crude and useless steel dog muzzle will not help me to avoid the attention of the police (who remind me that my dog MUST wear a muzzle) when I take her for a walk.

So now, woefully sleepy, I'll just go to sleep, as I should have done fourteen hours ago.

There is also a terrific "opportunity cost" to spending the night on unworkable projects while others are chatting at music bars with their friends, or simply sleeping with a loved one.

Willful Sleeplessness

I have been very willful about not going to sleep at all last night, but instead spending the night inventing a steel muzzle for my dog, since the laws here require some kind of muzzle here and my dog has broken muzzles made of leather, light steel, and cloth. So, I'm welding something together that unfortunately looks much like tool of torture, but my intent is simply to keep her from being sacrificed by the police or dog catchers.

January 07, 2009

Suicidal Sleep and Wakefulness

During certain periods, I think about suicide all day long; I go to sleep ruminating about it, and I awaken ruminating about it, picking up precisely where I left off. I didn't have that experience last night or this morning. And my surfing on the Internet before I slept did not depress me so much that I was angry and wanted to die.

Speaking all of which, I guess I should go and take 100 mg. of sertralina /sertraline (Zoloft) and 100 mg. of carbemazepina /carbemazepine (Tegretol/Tegrex), as my first dosages of these medicines for the day. Did I already take them? I can't remember, but a little bit extra is unlikely to hurt me.

I Slept Soundly Until the Phone Rang

Well, last night(actually at 4 A.M.) I convinced myself to sleep by downing four times the regular quantity of clonazepam. Don't do this at home! That and printing some pages from the New York Times and taking them to bed with me for reading is what allowed me to sleep, and in pretty short order.

In fact, I probably would have slept hours earlier had I just taken the New York Times to bed with me, but a symptom of manic depression and hypomania is the unwillingnesss to sleep, even when we feel tired.
A condition seen on rare occasions is “chronic hypomania,” in which people habitually sleep less than 6 hours a night, are constantly too enthusiastic, too busy, full of plans, and full of restless impulses. Essortment.Com
Early this morning, around 2:00 AM, a man came from the gas station across the street and asked if I was sawing something, because it sounded like perhaps my house was being robbed. In fact, I was sawing off two of the legs of my bed to make them equal to the other two. (All four legs need to be 50 cm (twenty-five inches or so), so that I can store all of my junk beneath the bed.) I guess those count as "restless impulses", since few others can be found sawing off the legs of their beds at 2:00 AM, in a manner that attracts the attention of the neighbors.

This is a longstanding impulse. When I was 19 years old (27 years ago), the neighbors called the police because I was sawing studs to renovate my bathroom at three in the morning. Some things never change and some only change with great difficulty and psychoactive drug intervention.

At nine this morning, the phone rang, and just as well because various people were looking for me, to charge me for my accounts and etc. I don't feel as though I took 8 mg of clonazepam last night, just six hours ago.

January 06, 2009

Why Hasn't the Clonazepam Put me to Sleep?

Well, it's 3.43 AM and I'm still not asleep, in spite of having taken 2 mg of clonazepam at 10:00 P.M., before I went to my friends house, with my dog, for dinner. I imagined that taking the pill before I went out would give me a chance to come home good and tired and sleep, but I was apparently wrong.

They say that clonazepam can cause "depressed mood, thoughts of suicide or hurting yourself", but I had these before I took clonazepam, and these symptoms don't seem to have gotten any worse, although they sometimes get as bad as they were pre-clonazepam. Drugs.Com

Sometimes, out of frustration with life and a vague desire to hurt myself, I take three or four Clonazepam tablets at a time. But, I've read that some people have taken sixty at a time and lived to tell about it. The risk is of addiction and increased tolerance - risks I can't do much about, and risks that are perhaps not as dangerous as going night after night without adequate sleep.

Less serious clonazepam side effects may include:

  • drowsiness, dizziness, spinning sensation;

  • memory problems;

  • tired feeling, muscle weakness, lack of balance or coordination, [etc.] Drugs.Com

    I've felt all of these symptoms. Often, we have to climb high hills in this neighborhood, and my friends don't understand why I climb with such torpor. I've read the side effects of these medications to my closest friends, with some success.

    It says here that Clonazepam should only be taken for a short time, like nine weeks. "Clonazepam should be used for only a short time. Do not take this medication for longer than 9 weeks without your doctor's advice. " I've been taking it for a year. I'll have to ask my psychiatrist if that's something we should be concerned about. I'm not terribly afraid of becoming addicted to drugs anymore. I figure that the risk of killing myself (or somebody else) without them is a more immediate concern. But, I'll ask my psychiatrist anyway.

    and "Klonopin" are just other names for Clonazepam, and everyone knows that Klonopin is for kooks beyond redemption. I guess this means I am either a kook beyond redemption, or I've had a prejudice against Klonopin that was unwarranted. Neither would surprise me.

    Well, to help me sleep, I tool another six milligrams of clonazepam. It's a desperate act that falls somewhere between medication and a futilely inadequate suicide attempt. I've taken ten before and not fallen asleep, so I know that three won't kill me. All I need to do is get into bed with something to read and I will fall asleep. So, why am I being so resistant, so stubbornly resistant, like a child who fights sleep until it overtakes him like an irresistable tidlewave.

    I used to feel anxiety at not sleeping because of my many responsibilities of the following day. Now, I've reordered my life so that the biggest consequence of not sleeping now will be sleeping later, when everyone else is awake, going about their business. Perhaps I should take twelve more clonazepam tablets? Perhaps I should read myself to sleep?

    Is My Wife Cheating on Me?

    I've moved sixteen hours away by bus to get away from my stepson, because he and I simply don't like each other, and I don't like living with him. In the process, I have had to leave my wife and two stepdaughters behind.

    So, when I am away, does my wife go out with other men? There's really no way for me to know, except to ask her and hope she tells the truth.

    I chat with other women. If my wife finds another man, I hope she tells me simply, so that I can go on with my life without too much emotional disruption. I can accept it if she needs the comfort and support that I can't give her from so far away. I can accept it if I need a living circumstance that living with my wife cannot provide. I just want to continue to be friends, without rancor, as I am with other ex's.

    So, I want her to be honest with me about what's going on, even if I soft-peddle much of my activities so as not to alarm, hurt or anger her, or needlessly arouse her jealousy.

    My Blog Site Meters Are Depressing

    Unless I make a grand effort to attract traffic to this and my other blogs, a few visits a day is normal for me. Are people uninterested in what I have to say? Have I become irrelevant and worthless? Nugatory?

    I write because I need to express myself, regardless of how many people read what I've written. And yet, I've realized that I check my site meter at this and my other blogs to see if I still mean anything to anyone. And when I discover that my popularity is sinking, that fewer and fewer people are reading my blogs, that's yet another reason for depression.

    I'm failing, in a way, because of my success. This interlinked incubator for voices that I have helped create has created so many voices and given them such prominence that mine has become just one of a cacophony. The band has become so large, that my flute is barely heard, and rarely do I set the rhythm with the drums. It's democracy that makes me only as important as my colleagues perceive me to be on any given day.

    So, I've stopped making my blog meters an obligatory stop on my daily surfing. If someone reads, fine. If not, I have expressed myself to myself, researched and ordered information in a way that is meaningful to me and, like masturbation, it need not give anyone else an orgasm to have achieved its purpose.

    How I Made My Dog's Muzzle for Two Dollars

    In this new town in which I live, large dogs like mine have to wear muzzles, by law. I have gone through four muzzles and countless collars for my full-grown German Shepherd, because she simply doesn't like them. She pulls on them until she tears their fiber and/or steel to shreds, or until I lose all desire for walking with her. She bucks like a bronco that can't be broken.

    Many people have suggested choker collars, but my dog just pulls until her throat is sore and infected, and needs medication. She gave herself a week-long fever this way, requiring medicines, baths, and respite from all collar use entirely. Store-bought chokers and collars and muzzles simply are to uncomfortable and unsufferrable to work on my German Shepherd.

    Yesterday, I bought a six-inch piece of 4-inch diameter PVC pipe (typically used for downspouts and waste pipes, and I drilled some quarter inch holes in it. I threaded it in various ways with 3/16 inch steel cable, covered with plastic (available at most hardware stores, and I put this homemade four dollar muzzle over my dogs mouth, threading the cable through her collar so that she can't remove the muzzle just by pulling on it.

    This is the most comfortable muzzle she has had, leaving her nose completely unencumbered and allowing to drink at will, even with the muzzle on. She doesn't seem to resist keeping the muzzle on even in the house, which makes it far easier to me to spontaneously go walking with her, without fighting her over putting a muzzle on.

    I think I will paint her muzzle "Publish Post" orange, so that she will be more visible in the night. She likes to walk ten yards ahead of me, so its safer, right, if she's more visible? I might mix yellow and red paint, or I might save myself some trouble and by some orange spray paint at the hardware store.

    Explaining Carbemazepine / Tegretol / Tegrex

    One of my closest friends in town, (my barber) came over tonight. I decided to explain to him about my mood swings and about the Tegretol I am taking in an effort to get them under control, ie. stop feeling suicidal every night. Since he wants to learn English, I asked him to read the following paragraph from http://www.minddisorders.com/Br-Del/Carbamazepine.html about carbemazepine, to help him to understand my challenge and my situation:

    Recommended dosage

    When used to treat seizure disorders or psychiatric disease, the recommended initial dosage of carbamazepine is 200 mg two times each day. If needed, the daily dosage may be increased by 200 mg once each week. Total daily dosages should not exceed 1,000 mg in children between the ages of 12 and 15 years. Total daily dosages for adults should not exceed 1,200 mg. Carbamazepine should be taken with meals. http://www.minddisorders.com/Br-Del/Carbamazepine.html

    Wow! I have been taking 200 milligrams of carbemazepine a day for over a year, not realizing that this might be a nearly uselessly small dose. I've been taking one sixth of the maximum recommended dosage, and one half of the recommended starting dosage. I should have talked with my psychiatrist about this months ago, but I was afraid that if I divulged the thoughts that were making me uncomfortable then my psychiatrist might think I should be hospitalized. I'd much rather die than be hospitalized again, after a "bad trip" on on the last occasion.

    My barber asked me why I was sharing this intimate information with him, but I told him that in any new town one has to take a small few people into one's confidence. I've chosen him, and two other close friends.

    He admitted that he had learned a lot of new words in the process. He said that 20% of the words in the text were new for him, so I said that talking with me about my psychiatric situation is a good way for him to further his English learning. He also thanked me for sharing this confidence with him.

    January 05, 2009

    Taking More Tegrex / Tegretol / Carbemazepine / Carbemazepina

    Having spoken with my psychiatrist, he says it was always his intention that I take more than 50 mg of Tegrex per day, once I got used to the lowest dose. But, I didn't get back to him about it and stayed on the lowest dose for a year. I thought only kooks would need to take more than 50 mg of Tegretol, which shows another bias under which I've been laboring, perhaps at great cost to myself.

    Anyway, I'm going to take 150 mg of Tegrex from now on and see what happens.

    I have to get up early in the morning to get a consult at the free hospital, and I am still awake at 23:44 P.M. I will have to wait in line for at least an hour. Meanwhile, I may not get much sleep first, because sleepiness has reached me now, but not overtaken me to the extent of forcing me to sleep.

    Since I've been seriously considering cutting my head off with a chainsaw, therefore taking more medicine is a relatively conservative approach to my head problems. "If thy head offendeth the, cut it off." I know I read something vaguely like that in the Bible, but then I don't pay the Bible much attention anymore anyway, so there's no point in relying on it for permission to cut my head off.

    I could also take more sertralina (Zoloft) since I am only taking 150 mg per day, while 200 is the maximum recommended dosage and I've heard of people taking 275 mg per day without adverse immediate results.

    January 04, 2009

    Hypomania and Sleep Medications

    Since I was twelve years old, I did not want to sleep at a normal hour. I preferred to play chess until four in the morning and then try to get to junior high school by 6:45 AM, which was essentially a fool's errand. My lateness and torpor and intellectual and emotional absence at school were foreordained by my (not) sleeping patterns. I typically rolled into school around ten AM and then had to ask at the office what my locker number was and what my combination was.

    Who can remember such details on so little sleep? Now, I read that it is a typical symptom of hypomania to find it virtually impossible to sleep until one is simply too tired to keep his eyes open any longer. (I well remember slipping off of my chair onto the floor in science class in seventh grade, because at that moment it became impossible to pretend to be awake any longer.

    So, now I take Clonazepam/Clopam an hour before I think I should go to bed. An hour later, my body calls out for sleep with medicine the way others' bodies call out for sleep without medicine. I become greatful to be going to sleep instead of mortally resistant.

    Now, the issue has arisen whether a person who takes so many medications should drive a car and operate heavy machinery. I my case, it was far more dangerous for me to do so without these medications than with them. Should an epileptic drive with or without taking his seizure medication? Optimally, he would not need to drive at all, but it seems to me that since the purpse of the medication is to reduce seizures, it's better to drive having taken the medicine than to drive without it. That's just my opinion. I know I'm a safer driver when I'm not actively suicidal or full of amorphous anxiety and unvented fury.

    Sertralina / Zoloft: What About It for Me?

    Psychosite says this about Sertralina, also known as Zoloft:
    Para que serve ?
    Suas principais indicações são para o tratamento da depressão e do transtorno obsessivo-compulsivo.

    Como é usado ?
    Geralmente da dose de 50mg por dia costuma ser suficiente, menos do que isso não costuma ser usado. Quando necessário a dose diária pode se elevar até 200mg por dia. Como os comprimidos têm 50mg fica fácil fracionar a dose ao longo do dia. Deve-se tomar preferencialmente pela manhã.
    Although people in Twelve Step abstinence programs often think they are week if they cannot abstain from street drugs without the use of prescription drugs, I found that my obsession with chasing women was reduced considerably and became more manageable when I began taking anti-depressants. I wouldn't be surprised if the same were true for alcohol and cocaine, since so many drug addicts use to hide feelings of depression.

    Likewise, I've just read that Tegrex/carbemazepina can be helpful in reducing the sickening effects of going without alcohol in the first weeks. I used to have prescription drugs. Then, I was humbled by my own sickly mind and I became a real proponent of taking the prescription medication that can help a person feel better and get over the hum of detoxification, be it from women, cocaine, alcohol, betting or cat-fucking.

    Sertralina is also known as Zoloft. I never wanted to try this drug in my home country, because (1) my second wife took it and she seemed quite nutty, and (2) the name "Zoloft" turns me off. It sees like it's a drug for particularly nutty people, like Clonopin.

    And yet, in Latin American languages "sertralina" sounds benign enough, and it also one eight the price for a monthly supply here compared to the United States. That's worth a try. My doctor here told me that it was a new drug in these parts, but it's been around at least ten years in the United States, since when my ex-wife was taking it.

    The Brazilian site Psychosite says that 50 mg per day is a normal starting dosage of Sertralina/Zolof, but that 200 mg per day, preferably taken in the morning, is the upper limit. Since I still feel depressed much of the time, I can't see the harm in trying the upper limit and seeing what it does for me. I tend to be pretty resistant to psychoactive medications (I used to take 80 mg of Prozac per day), so it wouldn't be strange for me to need 200 mg of sertralina/Zoloft to get the desired effect.

    However, I don't want to change two medications at once (Sertralina/Zoloft and Tegrex/carbemazepine, because if there are negative side effects I won't know which drug (or combination of drugs caused those side effects), and if I better I won't know precisely why. So, I'll take more Tegrex for a couple of weeks and then try an increased dose of ZZZoloft as well.

    If I'm Hypomanic, What Medication Should I be Taking?

    It's generally considered a bad idea to increase one's psychoactive medicine threefold without consulting with a doctor. But it's also considered a bad idea to cut one's head off with a chainsaw. Of the two bad ideas, I prefer the former tonight. So, I'm going to start taking 600 mg of Tegretol (carbemazepine/carbemazepina) per day instead of 200 mg, which I consider to be an insufficient dose, and the literature supports this. (Don't do this at home, especially reducing prescribed medication because you feel you don't need it anymore. That's most often typical manic self-delusion and wishful thinking.)

    Now, at the About.Com: Bipolar Disorder webpage, there are warning signs for mania, hypomania and suicide, by Kimberly Read. I'll apply these to my self below in the parenthesis, and see how I do, while the warning signs themselves are highlighted in red:

    There are a number of warning signs of manic episodes, red flags as many call them, of which we should be aware. By learning these early indicators, red flags will go up before a loved one rockets into a manic spree, before you slide into depression, before a friend actually attempts suicide.

    In this article, the first in a four-part series, we look at some of the common red flags for mania and hypomania. Part II looks at depression flags; Part III, the warning flags for Suicide; and Part IV, the early signs of childhood-onset bipolar disorder (COBPD).

    These symptoms are organized into broad categories for easier reference; this list of symptoms is gathered from personal experience as well as the resources listed elsewhere on this page.

    Increased energy

    • Decreased sleep: (I've been sleeping pretty well, since I started taking 2 mg of clonazepam an hour before bedtime. Otherwise, I would stay up reading the newspapers online, or writing, until six in the morning. My wife would call me to bed, but it was no use. Often, I'd go out to an all-night restaurant or take my dog for a long (two-hour) walk on the beach. During my second marriage, I used to leave the house at 1 AM and then walk seventeen miles until the sun came up.)
    • Little fatigue: (I feel very often fatigued since I began taking the 2 mg of Clopam (clonazepam) before bed, along with 200 mg.of carbemazepine (Tegrex) as a mood stabilizer, and 150 mg of sertralina (Zoloft) per day. If you've had the experience of using up 2,800 minutes of cellphone time in one month, you might consider a little bit of sleepiness to be a welcomed respite, as I do, mentally and financially.
    • An increase in activities: I've been called a whirlwind and had established residences in three countries over the course of six weeks. Let's leave it at that.
    • Restlessness: I've come to the conclusion that sometimes the only alternative to losing my mind is traveling, regardless of the cost and consequences. For me, seeing something new and encountering and coping with new circumstances and people works like electric shock therapy works for others. It distracts me from the immediate past and helps me get involved with the present, at least for a time.
    • Is having been married three times a symptom of restlessness or simply of poor decision-making?

    Speech Disruptions

    • Rapid, pressured speech: Sometimes I NEED to talk to someone. I used to talk to suicide hotlines for hours. But no one said my speech was "rapid" or "pressured". I merely felt pressure to continue speaking for fear of what I might think and do when I was alone again.
    • Incoherent speech (generally not present in hypomania)
    • Clang associations: the association of words based on their sound
      (For example, my ex-husband once carried on for some time about vacancies, vagrancies and bacon seeds.)

    Impaired Judgment

    • Lack of insight: Do three marriages show lack of insight?
    • Inappropriate humor: I often laugh at movies while others are in shock, cowering beneath their seats. This really ruined a first date one time, and makes people think I'm insane, which I just might be. Once, I was laughing and jovial when my friends visited me in a mental institution after a suicide attempt. When they left, I cried on the floor of my cell. (OK, that's an exaggeration. It was simply a hospital room with no "sharps".)
    • Inappropriate behaviors: Would coming on to every woman I know count as an inappropriate behavior? That's what I did before I started taking this cocktail of medicines that I'm taking now. For example, I was going out with a girl who was a twin and I asked her if they wouldn't both like to have sex with me at the same time. That was perceived as "inappropriate", and caused some very hurt feelings.
    • Impulsive behaviors: Would telling the customer service woman at the telephone company to suck my dick (in the presence of my fiancée and her mother) count as an impulsive behavior? Would driving 105 miles per hour in the breakdown lane count as an impulsive behavior? Would utterly destroying an isolation room in a mental hospital count as an "impulsive behavior". I wouldn't have done it if I had foreseen the results.
    • Financial extravagance: I used my mother's credit card without her permission to purchase tennis lessons. Is that financial extravagance or merely an overwhelming desire to stay fit?
    • Grandiose thinking: Hmmm. You never know what's grandiose until you try and fail or succeed.

    Increased or Decreased Sexuality

    • May include inappropriate or sexual behavior: Would asking a cousin twice my age to have sex with me count as "inappropriate sexual behavior"? Would sex with same-sex strangers count? Mores are changing so quickly in this area.

    Changes in Thought Patterns

    • Distractibility: It's very hard to distract me. Once I get my mind focused on something, it becomes an obsession until it is complete.
    • Creative thinking: Yes. I have my own word in Wikipedia.
    • Flight of ideas: Yes. I don't have the flight of ideas typical of flagrant manic depression, especially having experienced such behavior at first hand in my brother and cousin.
    • Disorientation: It's been a while since I felt truly disoriented. I think I was traveling in South America at Christmastime, and couldn't figure out what the hell I was doing there and why. So, I bought a plane ticket and traveled somewhere else, where I still felt disoriented. That might be considered symptomatic of "disorientation". But, that was almost thirty years ago!
    • Disjointed thinking:
    • Racing thoughts

    Changes in Mood

    • Irritability: Does breaking the sink with a chair count as irritability?
    • Excitability: I'm pretty calm, except when I believe that the world is coming to an end and I might as well kill myself.
    • Hostility: My ex-girlfriend says that just before I admitted myself to a hospital, I smashed a number of objects in the house and then left the house with a sledge hammer, promising to do something significant to somebody with it. While I was too tired to remember that very well (it was about three in the morning), I do well remember jumping onto the hood of a car at a traffic light and ripping the windshield whiper off, because the driver stopped abruptly next to my leg.
    • Feelings of exhilaration

    Changes in Perceptions

    • Inflated self-esteem
    • Hallucinations (not present in hypomania)
    • Delusions (not present in hypomania)
    • Paranoia (generally not severe in hypomania)
    • Increased religious activities: Would driving three hours per day to sing in three different choirs at my church count as "increased religious activity"? Would it matter if I drove to choir rehearsal at 100 miles per hour?
    Hypomania also differs from bipolar mania in that the symptoms are generally less severe so that they do not cause significant impairment of daily activities. There are no psychotic features present in hypomania: I'm not aware of any psychotic features in myself, so hypomania seems a more appropriate diagnosis, although a battery of psychiatrists has disagreed with me. Medications aimed at "simple" mania don't work for me, which might be dispositive, and anti-depressants DO work for me, which might also be dispositive.

    More often than not, those who are close to us will notice our little red flags long before we will. If someone you love is waving flags, express concern. And if someone you love expresses concern, listen. My friends notice changes in me, but they have no knowledge of the information above. Some of them urge me to try to become independent of the medicine I'm taking, but I compare it to insulin and I ask them if insulin dependent people should try to ween themselves off of it?

    Whenever I raise these issues with my brother, he is so desperately uncomfortable that he just wants me to shut up. Maybe it's because my uncle and my brother had manic depression and he's afraid his own children might be next. Or maybe he's just shallow, superficial and petrified. Maybe he simply doesn't care? In any case, I've stopped talking with him, since my every feeling and perception is a landmine for him.

    Having known a number of people who were manic depressive, including the psychotic features, I don't think I'm manic depressive. I think I'm hypo-manic. So, what does that mean in terms of developing and effective medication regime that can keep me from rapid cycling from happy to despondent in the course of twelve or fewer hours? That's the question.

    January 03, 2009

    Carbemazepine (Tegrex, Tegretol) and Me

    I've been taking carbemazepine for a year, although I've had mild to moderate symptoms of manic depressive disorder (everything but psychosis) since I was a teenager. And yet, when I began taking carbemazepine, I only spoke with a doctor whom I trusted once and began taking one 200 mg tablet per day, in the morning, often without eating any breakfast first.

    Now, because I often start the day feeling encouraged and singing and end the day feeling despondent, morbid and preferably dead, I am considering taking more carbemazepine. And as I read literature on the Internet, this seems like a perfectly reasonable idea. For example, an article entitled "CARBAMAZEPINE THERAPY: What is Manic Depression?", says:
    How should carbamazepine be taken? Carbamazepine is usually taken in divided doses over the course of the day usually 3 or 4 times daily. To minimize side effects most doctors will gradually increase the dose until the desired effect is achieved. Later the dose may again be adjusted with the goal of finding the 'minimal effective dose' i.e. the least amount of drug needed to obtain the desired side effect. Many people prefer to take their medication with meals, which not only help them remember to take it, but also helps to avoid nausea that may occur if it is taken on an empty stomach. CARBAMAZEPINE THERAPY: What is Manic Depression?
    Since I've only been taking one 200 mg tablet per day, I'm going to increase that (Yes, "I") to 400 mg and see what happens. I'm going to contact a psychiatrist to confirm this decision, but not one who lives close to me. If they find out that I'm actively considering suicide much of the time, then they might want to put me in a hospital (and I might want to go at first), only to find myself locked up and unable to get out without someone else's permission.

    Actually, I am at high risk for suicidal behavior according to standard criteria, because I have recently moved away from my wife and the town where I lived for four years; I have an anemic social system where I now live; I have acute financial troubles and worries; and I have a history of suicidal behavior and gestures, as well as hospitalizations. What's more, I have talked about suicide with virtually everyone I know (I asked my barber to slit my throat with his straight razor).

    The only missing ingredient seems to be drug and alcohol use, which would at once potentiate the other drugs I'm taking (make them stronger as potential poisons), remove my inhibitions and judgment, and make me more likely to engage in risk-taking behavior. If I really wanted to die, I would have to start drinking (grain?) alcohol in large quantities, along with much larger doses of the other medications I'm taking.

    And all of that still might not work. It might only land me in a mental hospital where I would have fewer choices than I have now. That's why I've decided that if I'm going to kill myself, I'm going to behead myself.

    Since I don't have a history of beheading myself and I do have a history of trying various medications to make me feel better, it seems more in keeping with my past behavior to just try more carbemazepine and see how it works.

    Oh, one more thing: I don't drive anymore because my anger made it dangerous to do so. But, I'm sure it would be less dangerous to drive while taking this mind confusing drug then to drive like a maniac without it.

    January 02, 2009

    Tegrex Takes My Fury Away

    It's been roughly a year since I first wrote that Tegrex Makes Me Sleepy, Gives Me Torpor. A year into using Tegrex (carbemazepine), (if it still makes me sleepy and gives me torpor), I don't notice it anymore.

    What I have noticed is that the fury that I once felt, the extreme lack of patience and desire to smash something or tell someone to go fuck himself, is gone. Pervasive anger is often a part of untreated depression (or whatever my problem is, at least for me), yet the Tegrex has treated the anger part of my "depression" successfully.

    I still have angry thoughts. Over the past week, and periodically since I was seventeen years old, I have been thinking about creating a guillotine of one kind or another (note the one I found to symbolize my mood when I started this blog a year ago) and the idea of cutting my head off is just as present today as it was a year ago.

    Lately, having bought a welding machine, and with an account at a store that sells gas-powered chain saws, I've been fantasizing about building a chainsaw-powered guillotine. Actually, I've been fantasizing about this since I was about seventeen years old. Did I say that already?

    I would have build a guillotine in my mother's back yard, but I think the neighbors would have seen it, and that would have let loose a cascade of unpredictable consequences, none of which involved me dying in peace on my guillotine.

    So, you might say that I'm still furious inside, but without the compulsion to act it out. That makes life more manageable, since in the period before I started taking Tegrex I bashed a marble kitchen sink into five pieces with a wooden chair, for an example. That sort of release felt good and necessary and justified in the moment, but left me with expensive troubles to resolve.

    Now, I am investigating the possibility of taking more Tegrex. When I talked to a state psychiatrist and told him that I was only taking 200 milligrams per day (of a potential 1,600 mg maximum dosage), he was notably surprised. "You're not taking 1,600 milligrams?" he asked with shock? But, he was trained back in the 1950's, when psychiatrists considered that an effective dose had been reached when the negative side effects became apparent. More recently, psychiatrists and psychologists believe an effective dose has been reached when the negative affect and behavior goes away, even if the patient doesn't have e.g. facial ticks and obvious torpor caused by the medication.

    Now, I'm reading online the patient insert for carbemazepine (which does not come with the medicine when it is provided for free by the Government pharmacy) and the insert says:
    The initial dose of 200 to 400 mg per day, should be increased slowly until the achievement of analgesia (in general, 200 mg, 3 to 4 times daily). Then gradually reduce the dosage to the lowest level of maintenance possible. Neurolab
    So, I'm only taking the minimum recommended dosage and 25% of the maximum recommended dosage of this medication. Maybe I should take more? Lately I feel great in the morning, singing on the way to wherever I'm going, and by ten o'clock at night I want to walk in front of a semi-trailer. I'm fantasizing about ways to kill myself. These are mood swings that occur on a very rapid basis, like the "rapid cycling" kind of bipolar disorder.

    The page says further,
    Acute mania and maintenance treatment of bipolar affective disorders: The dose range is 400 to 1,600 mg a day, and the usual dose is 400 to 600 mg a day, in 2 to 3 divided doses. Neurolab
    So, I'm taking merely half to a third of the "usual dose", and I'm taking it once a day, in the morning, instead of spreading two or three times as much medicine out over the full day.

    I'm going to contact my psychiatrist and propose that I take more, and see what he thinks. Meanwhile, I'm just going to take more on my own and see what happens.

    February 03, 2008

    Is it True that "Depression is a Choice"?

    If my depression is a choice, then I must choose to be depressed for two weeks and then to NOT be depressed for two other weeks, intermittently. I don't think that makes a lot of sense.