boozewithoutthebooze

So things were getting dark for me pretty fast after the new doctor increased valproate. It’s actually very hard to see the causes of these changes; despite being aware that you have changed your diet, the changes in how your mind functions can make you unable to spot them.

I think that valproate really is like booze for me. They act in different ways, but both have the effect of increasing GABA, which lowers inhibition. For someone who is struggling with periodic anger I think this can be good, and in January when I was about to implode I needed a drink, so valproate is just what the doctor ordered.

But since then I have been taking valproate the whole time, and was gradually slipping into depression. Aripiprazole happened and threw everything out the window, but while taking aripiprazole I actually tapered the valproate to near-zero. I was already high, and that might have made me higher, but actually what I think it did was take the brakes off a little. Honestly I think the impact was minimal.

But reinstating it I noticed my anger became more explosive, small things irritate me more, and I rapidly fell back into a sped-up version of the cycle I had when drinking: get angry, feel depressed, try to make it up. Except I was never a daily drinker, so having this crushing depression on a daily basis was making me almost suicidal.

My wife has joined me in these last two doctor sessions and I’m happy she has. The doc said that the patient spots depression first but the people around them spot mania, and I have been getting so frustrated with this ‘bipolar manic’ narrative that it’s hard to put into words. I am sleeping. I do not feel invincible. I never have. I just have a higher functioning baseline than most people.

I talk fast. My brain is fast. I am usually 3 steps ahead and pre-empting answers. But this is not mania. I have built companies. I have gone from alcoholic to ironman world championship level fitness. I have moved all over the world and started over many times. I survived aripiprazole. I learned Japanese in 3 months. I aced all scientific and linguistic subjects without study and was the smartest kid in a school of 2000.

I still don’t feel invincible and never have. The things I do have always scared me and I have always done them intentionally, making sure that I build a ladder and only go one rung at a time. I have data suggesting I am capable of this. This is not mania. Mania is not a scientific term. For me I build a 6-9 month plan and then stick to it and then burn out. Mania does not last 6-9 months. And aripiprazole was drugs; you can’t judge someone based on how they behave after a gram of cocaine.

Anyway my wife was asked questions about my mood, sleep, activity; it rapidly became clear that I am not manic. If anything I am depressed. And the doctor actually listened. God I hate that word mania. It really does not have a scientific basis. There is no ‘cause’, since bipolar 2 and cyclothymia are so fucking fluffy and this is where mr scientific fucking method should step in and do his fucking job.

But anyway we have lowered the valporate. The doctor is wary and wants me to keep a half dose at least for this week, but listened to what worked for me previously and gave me some guanfacine. 

Guanfacine feels like a good one for me; it lowers perceived adrenaline. Subjectively it helps me sleep, but most of all I remember it allowing anger and other such agitations to actually be processed and leave my body. One of my major issues is that anger gets ‘stuck’ in me for hours on end, and never really leaves; it just gets embedded. I run or life weights or just grit my teeth and it dies down, but it never abates fully. Guanfacine enables this anger to actually leave my body, where valproate just squashes it down until it eventually explodes; the old boiler-pressure-build I talked about when stopping drink 5 years back.

So now I’m back down to 400mg valproate, and have reinstated 2mg guanfacine, along with 0.5mg rispiridone for irritability. Risipiridone is the alternative to aripiprazole for aggression is ASD kids, but it doesn’t seem to have the partial dopamine agonist effect so shouldn’t cause a similar episode.

I feel like once settled on this it could be worth trying lamitrogine - this is used for both epilepsy and bipolar; it increases voltage gating in the brain which prevents seizures. It also has antidepressant effects, which I wouldn’t complain about.

For now I have moved to our new house, to be on my own for a while. I need peace and predictability. I need the kids, but without the evening stress, and I certainly never want to play The Game of Life which they are hooked on. 

I need to treat this like an actual sickness and allow myself space to recover. 

This new doc was like ‘take months off work and drop all responsibilities’, The old one was like ‘heres a years worth of random drugs now back on the horse’. Even disregarding the initial episode in January, the aripiprazole incident alone would take 6 months to recover from fully; maybe more given how intense it was.

So for now I will make knives and play wholesome save-the-world computer games. I will avoid conflict or anything which could become conflict. I’ll treat myself like a patient who needs to recover, because that’s what I am.

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