The LAST Treatment Update

Tomorrow I am discharged and headed home. From start to finish, I was an in-patient here at NIMH for one week shy of five months. For the first few weeks, I was quite aware of how different this place is compared to Birmingham and my life there. Since I made a point to get out and about as much as I could, I almost feel like a DC native now. I keep up with local news, I ride public transportation daily, I'm aware of the history and peculiarities of many neighborhood enclaves, I often frequent cultural offerings, I attend First Hour nearly every Sunday morning at the oldest Quaker meetinghouse in the area, and at last count I've visited almost every museum, historic home, art cinema, bookstore, notable landmark, and also stopped by many of the restaurants, coffee shops, and trendy bars.

With time and with the assistance of a close friend who I grew even closer to as time went on, I've developed a social network of friends and fellow Quakers that I am understandably not looking forward to leaving. DC has much to offer in the way of culture and shared commonality in great proportion. I've felt a part of something larger than myself to a supreme degree I have never experienced before anywhere else in my entire life. I used to believe that I never would. Critical mass really makes all the difference in the world. Without it, one must experience the loneliness of knowing what one needs to find companionship and simply not having the necessary resources, nor the ability to reach out and connect with like-minded others. I used to believe that I was doomed to be out of step with almost everyone, but if being here for a long time has taught me anything, I am now aware that I at least know a place where I feel like I belong. I knew I would always have to go north to find it. In grad school, I took a class whereby one whole seminar's discussion focused on a prominent southern liberal intellectual historian who, while he found much to appreciate in his region of birth, never truly found contentment until he migrated north of the Mason-Dixon line.

My medication regimen upon discharge is as follows:

• 30 mg of Parnate (anxiety, depression)
  
• 1350 of Lithium (mood stabilization)
  
• 500 mg of Seroquel (mood stabilization, sleep, and depression)
  
• 8 mg of Rozarem (sleep)
  
• 12.5 mg of Ambien CR (sleep)

A few minor problems have made my last week on the unit a little uncomfortable. After having the hypertensive crisis two weeks ago, I've developed a mild PTSD-related response, whereby the worry and anxiety I often feel when eating unfamiliar food makes me overly cautious not to have another one, which paradoxically creates a panic attack. Those of you who have had a traumatic experience know that the immediate effects rarely stop when the crisis is over. Effects linger. Two nights ago I spent three solid hours staving off one attack after another, which though I know how to neutralize them when they arise as a result of long hours spent doing Cognitive-Behavioral Therapy, was a still a frustrating combination of very scary, tremendously annoying, and wholly time-consuming. Thankfully, last night was not like that and my hope is that this phenomenon will quickly subside. Perhaps ruminating about returning to Alabama has somehow fostered this or at least worsened the symptoms.

Sleep is often an issue for the manic-depressive and in that regard I am no different. Parnate causes a decrease in sedation and cuts down on the number of hours one receives from start to finish. This is why medications for sleep are often prescribed alongside an MAOI inhibitor even for those who prior to taking that class of anti-depressants have had no documented problems getting a restful night's shut-eye. Even with the problem my illness creates in and of itself, I have a long history of insomnia on my mother's side of the family, most of whom have some degree of mental illness, though they refuse to acknowledge it. Instead they drink away their worries, the way only those who are consciously unwilling to be self-aware can do. With my depression and bouts of mania, the onset of both occured relatively early on in life, so I have grieved them accordingly and made appropriate acommodations in my daily life. Severe insomnia, however, is a recent problem, and as such it still upsets me deeply when I think about how easy it was in an earlier incarnation to fall asleep without having to devote so much time and effort towards it.

Parnate has been a very effective medication, food reactions aside. Anything that allows me to get out of my head and not have to constantly negate negative self-talk and illogical intrusive thoughts is an absolute blessing. I will probably up the dosage slightly to 40 mg upon consultation with my Birmingham psychiatrist for an additional guard against anxiety, hoping to achieve an added level of protection against the panic attacks. Lithium will stay as is because I've reached the proverbial "sweet spot" of 1.0 blood concentration. Seroquel could be upped to 600 mg if sleep become more problematic again, and could even be increased as high as 1200 mg, though that would only transpire in an extreme case. A dose that high is used almost exclusively for schizophrenia, not bi-polar. Rozarem has been surprisingly effective in deepening my sleep, producing vivid dreams, and prolonging periods of REM. Ambien CR I have only recently started, but it hastens the onset of sleep and keeps me snoozing long enough that I feel sufficiently rested when I wake up in the morning.