Two’s Company, Three’s a Crowd: The Third Person Arrives

This may sound trivial to some but I have found it really fascinating. Firstly because I noticed it as, only what I can relate it to, a third person looking in. Secondly the more I have sat back and thought about it, the clearer the consistency of what I’ve been doing in two separate, different activities is identical. I haven’t been applying myself to the activity but applying my levels of perception of what is adequate understanding of a subject to them instead.

Let me explain. The first activity is playing the guitar. I only want to be able to play every Oasis song on it. Nothing more. Now after 7 years or so I can only play the intros to each song competently and then there’s a few songs, maybe 10, I can play all the way through. I have had some periods of bipolar depression when I was not able to function never mind play the guitar but even so, that’s not an excuse. If you say 2 years for the time to deal with the bipolar still leaves me 5 years. I don’t know what it is that stops me finishing off my goal. Maybe it’s because the intro of songs is the part people go mad at when they hear it at a gig or wherever?? Maybe if I do it then I have to find something else to focus on? But I’m not focusing too much on this am I? Or should I just relax and let the time come to me when I’m ready to go for it. There’s no rush is there??

The second activity is my ongoing study into the medication used in psychiatry, drug metabolism, guidelines for psychiatric prescriptions, bipolar disorder, my old medicinal chemistry books, lithium and it’s origins. I’m currently looking at the fact where lithium sits on the periodic table by sodium, being in the same category of elements, meaning they share similar behaviours, meaning possibly ‘two’ much salt tastes revolt(ing). In the body sodium is involved in a whole host of biological reactions and I’m researching if lithium could possibly interfere with sodium and alter the equilibrium of the bodies chemical make up. If I said to you that this is one of 14 areas I have started and I’m yet to get a conclusion on reminds me of the Oasis Hypothesis. But then again, searching for conclusions isn’t always a solution. I’m still researching aren’t I? The topics may all be individually unique but they are equally identical as they are all relevant to bipolar disorder.

I don’t know if I’m completely worrying about nothing and I just need to remember what the late, great Alan Watts once said;

Should We Question The Way We Ask Questions?!?

“Problems that remain persistently insoluble should always be suspected as questions asked in the wrong way.”

Alan Watts

What do you say when you’ve ran out of words to describe what is going on? Limited by a language yet this mind we have displays a different adage. Can’t understand it, can’t make our way around it. Can new words be created in a bid to have responses? Or are we just destined to be babbling complete nonsense?

Lets all get together, Bipolar, Depression, Schizophrenics and Medics. All Mental Illnesses invited to discuss and describe it, how our arsenal of vocabulary is just not broad enough to fight it.

“The problem comes up because we ask the question in the wrong way. We supposed that solids were one thing and space quite another, or just nothing whatever. Then it appeared that space was no mere nothing, because solids couldn’t do without it. But the mistake in the beginning was to think of solids and space as two different things, instead of as two aspects of the same thing. The point is that they are different but inseparable, like the front end and the rear end of a cat. Cut them apart, and the cat dies”

Alan Watts

So we are merely a host for our ailments? I just don’t buy it. As Alan Watts explained above, see it as 2 entities being one. Not separate from each other. We are always in a great need to separate ourselves from things rather than just getting on with it and experiencing what it is. We try to take the ‘I’ out of experience. Embrace what you are, you are you. Who dares to have the audacity and label, ostracise, brand and belittle people because of the way they are. You are not a stereotype.

Then there’s disrespect and a lack of understanding, or maybe it’s just ignorance and apathy, I don’t know, don’t care 🤷🏽 that means you have to act as though you don’t have a mental illness. That’s the really, really difficult part.

They say it is equal opportunities for all in the UK. You tell someone at a job interview you’re Bipolar and you’ve not got a chance in getting the job. The welfare state is not working for Mentally Ill people. You aren’t having a week off with a poorly tummy like Karen in the office. If you are lucky enough to be in work, you can have episodes anytime. I’ve had 6 months off in the last 2 years over two episodes. You receive SSP of around the equivalent of £10 per day.

Imagine What Would Happen If We Stopped Taking Our Pills? 💊

It makes you wonder though doesn’t it? Or maybe it doesn’t? But it definitely has made me ponder the question of what would happen, if anything, detrimentally to myself or others. Medication is prescribed on the basis of the pro’s outweighing the cons. Seeing the amount of cons potentially each one individually could bring in the concoction I take, justifies why Bipolar is classified as a S.M.I (Severe Mental Illness). Or does it? Are these pills more likely to be my downfall in later life? They all bring heart rhythm risks, then there’s liver problems and the lithium portfolio of side effects.

You are referred to a specialist, a psychiatrist, and given a treatment plan etc etc. You can refuse to attend appointments or not take your medication. You aren’t obligated to do either. You will have a reason why too. You know if it’s what you need and if you’re being listened to. Sometimes this response can get you detained under the mental health act. The Mental Health Act says when you can be detained in hospital and treated against your wishes. You can be detained if professionals think your mental health puts you or others at risk, and you need to be in hospital. If you are detained, NHS staff may be able to give you treatment, even if you don’t want it.

The only thing is that this treatment won’t put you back together as you were. You are remodelled, your brain chemistry altered by drug after drug after drug to become someone that looks like you, but really isn’t you.

Psychiatrist Appointment: Tuesday 2nd May, 2022

I’ve got my appointment this coming Tuesday that was originally scheduled for November last year. Due to the fact that the NHS, and especially the Mental Health sector is over stretched and under resourced, it’s nearly 6 months later than planned. I have still been in contact with my CMHT practitioner weekly and with starting the lithium in February, I’ve been attending my regular check ups and blood screenings. This was a reassurance that nothing was remarkable with my results and I was responding well to my treatment. However, I have been getting the odd fluctuations in moods and behaviours as the appointment grew closer. To the point I noticed them. Usually it’s others that notice it initially and I’m oblivious to them. This has made me feel that I need to tell him. A few close friends have said that I seem up one minute and down the next and chasing myself. Incoherence when explaining things etc etc. What I’ve written is just the first points that came to mind. They might read incoherent to you I don’t know. I know what I’m saying, or trying to say at least, but it’s getting lost in translation from my brain to my voice. I’ve always struggled with this and it was only when I sat exams through school, college and university that it was so blatantly obvious.

And Then There Were 3…

Semisodium Valproate ❌

My psychiatrist has decided to taper me off the Depakote and hopefully, I will lose a little bit of weight the 4 psych meds have added to me. I don’t want to lose too much though as I’ve just finished buying clothes that fit me 😂

I’ll keep you updated with my journey 👌

Medication Explained: Lithium Carbonate 💊

What is it?

Lithium carbonate is an inorganic compound, the lithium salt of carbonate with the formula Li2CO3. This white salt is widely used in the processing of metal oxides. It is listed on the World Health Organization’s List of Essential Medicines because it can be used as a treatment for mood disorders such as Bipolar Disorder.

Discovery

Some 70 years ago, John Cade, an Australian psychiatrist, discovered a medication for bipolar disorder that helped many patients to regain stability swiftly. Lithium is now the standard treatment for the condition, and one of the most consistently effective medicines in psychiatry. But its rise was riddled with obstacles. The intertwined story of Cade and his momentous finding is told in Lithium, a compelling book by US psychiatrist Walter Brown. Cade was a POW during World War II and after observing his fellow captives he saw a common trait that he was able to base his own knowledge and experience on, to unlock the door that has been the biggest advancement in Bipolar history. Amazingly too, he conducted his experiments in an old, disused kitchen in his native Australia. If you want to learn more about John Cade, in addition to the book previously mentioned, I highly recommend Finding Sanity. Link is below;

Finding Sanity: John Cade, Lithium and the Taming of Bipolar https://www.amazon.co.uk/dp/1760113700/ref=cm_sw_r_cp_api_i_G9P0M5YZ2BM3TKEJMVAZ

Mode of Action

Lithium is an element in the same group of the Periodic Table as Sodium. The ubiquitous nature of Sodium in the human body, involvement in a wide range of biological reactions and processes and the potential for Lithium to alter these have made it extremely difficult to ascertain the key mechanisms of action in Lithium regulating moods and behaviours.

The answer at the present moment is that we simply don’t know how it actually works. The most recent prognosis is that Lithium may have neuroprotective effects that preserve the functions of neurones and neuronal circuits. Also Lithium promotes the creation of new neurones in the hippocampus which is important for learning, memory and stress response.

Bipolar Disorder has previously been linked to the development of Dementia in later life. Recent meta-analysis of Lithium in animal studies however, has produced some promising results. The results indicated that Lithium may prevent the transition to Dementia. Notably though, both reversible and irreversible neurotoxicity related to Lithium are recognised adverse effects.

Common side effects

  • Headache
  • Nausea or vomiting
  • Diarrhea
  • Dizziness or drowsiness
  • Changes in appetite
  • Hand tremors
  • Dry mouth
  • Increased thirst
  • Increased urination
  • Thinning of hair or hair loss
  • Acne-like rash

Rare/serious side effects

Signs of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, vision changes, and unsteadiness while standing or walking. These symptoms need to be addressed immediately with a medical doctor to ensure your lithium level is not dangerously high.

In rare cases, lithium may lead to a reversible condition known as diabetes insipidus. If this occurs you would notice a significant increase in thirst and how much fluid you drink and how much you urinate. Talk to your doctor if you notice you are urinating more frequently than usual.

Are There Any Risks For Taking Lithium For Long Periods Of Time?

Hypothyroidism (low levels of thyroid hormone) may occur with long-term lithium use.

Rare kidney problems have been associated with long-term use of lithium. The risk increases with high levels of lithium. Your doctor will monitor your kidney function at routine check-ups to ensure this does not occur.

What Other Medications May Interact With Lithium?

The following medications can increase the levels and effects of lithium:

  • Diuretics, such as: hydrochlorothiazide (Microzide®), furosemide (Lasix®), bumetanide (Bumex®), torsemide (Demadex®), acetazolamide (Diamox®), chlorthiazide (Diuril®), and chlorthalidone (Thalitone®)
  • Non-steroidal anti-inflammatory medications (NSAIDs) including: Ibuprofen (Advil®, Motrin®), naproxen (Naprosyn®), celecoxib (Celebrex®), diclofenac (Voltaren®), and nabumetone (Relafen®)
  • Certain blood pressure medications, called angiotensin receptor blockers or angiotensin converting enzyme inhibitors.
    • Angiotensin receptor blockers (ARBs): valsartan (Diovan®), olmesartan (Benicar®), candesartan (Atacand®), losartan (Cozaar®)
    • Angiotensin converting enzyme (ACE) inhibitors: enalapril (Vasotec®), captopril (Capoten®), benazepril (Lotensin®), fosinopril (Monopril®)
  • Certain antidepressants, known as monoamine oxidase inhibitors (MAOIs). Examples include phenelzine (Nardil®), tranylcypromine (Parnate®), selegiline (Eldepryl®, Emsam®), and isocarboxazid (Marplan®)

The following medications may decrease the levels and effect of lithium:

  • Caffeine
  • Sodium chloride (table salt)
  • A medication used to treat breathing problems called theophylline (Theo–Dur®, Slo–Bid®)

My Personal Experience with Lithium

I commenced with my treatment on 11th February 2022. I’m glad I did and I’m in a very, very content place at the moment. The best I have been for a long time. I have started to get a routine in place for the first time in as long as I can remember. There’s still a lot of things that I need to do but I’m on the right track with it. I’ve made enquiries about a few guitar lessons to make me pick it up again and blow away the cobwebs. I’ve stopped drinking alcohol and I’m on orange and soda now. To be honest though, I wasn’t a big drinker anyway. I drank shandy’s and only at weekends. Started back with my language learning, Portuguese and Spanish, because it is so easy to forget what you once knew. Got myself some clothes and donated the stuff I didn’t wear to the charity shop. I’ve also been trying to eat healthy foods. I’ve not quite figured this one out yet as I’m still putting weight on every week. I’m bloody sure it’s the bathroom scales!

I take 3 other psych meds, Depakote (1,500mg), Quetiapine (350mg) and Mirtazapine (15mg). I’m also on Ramipril so there’s concerns for that raising lithium levels in the blood and causing toxicity. However, as I was already on the ramipril, the introduction of lithium could be boosted by it, meaning that I may only need a lower dose than usual to hit the therapeutic zone.

I take my full dose at night and try to take it at the same time each day. I started with 200mg, then up to 400mg and now I have 600mg. When you first begin with your Lithium Therapy, you have to attend a weekly blood test, along with a check on your blood pressure and your weight. As said before I put weight on after cutting all the shite out of my diet. I have levelled out now and I feel comfortable with my weight. I’ve still got a bit of a middle age spread but I’m nearly 40 so I can’t expect to have a metabolism like a teenager. You have to attend weekly appointments until your results show you are in the therapeutic zone and you aren’t in danger of toxicity. The therapeutic zone is 0.4-1.0 mol/I. I’m now on 3 monthly appointments. My own personal opinion is that I’d prefer to have weekly appointments. It not only checks your vitals but it’s also a chance to check in with your Health Team and talk. A problem you have on a Wednesday isn’t necessarily the same problem you have on following Wednesday or the date you manage to get an appointment. That’s the problem with Severe Mental Illness, there’s no manual on how to do a quick fix. I have been to the Pharmacist before while awaiting my appointment with the Psychiatrist and they aren’t allowed to advise. Now if I had a headache then they could. This highlights the most important issue in the UK regarding Mental Illnesses. The service is understaffed and overrun and needs the British government to address the problem.

What Does the Future Hold?

I don’t have the answer to this. Nobody does. For me though, I can at least predict what I hope it brings. I’m doing my own research on Bipolar Disorder and especially with the medication used. I’m not going to be a voice to be heard with my findings, but my understanding is that I am educated to university level in Applied Chemistry with Medicinal Chemistry and I have a passion for medicine and how it works. Also, I’m living with Bipolar Disorder. Forget being educated in bipolar, I am a living embodiment of it. I have started my research looking at the medication used for specific illnesses and then worked backwards to see the medications mode of action. Most of the examples I have looked at so far have been consistent with the fact that they have an issue further down the chemical process chain. So they are not treating the issue at source, merely masking it. This is the same for Bipolar Disorder. So if it’s a common problem, looking at a different example and getting a different perspective could open the doors for a whole host of advancements.

Living with Bipolar Disorder Explained: Social Anxiety

Behaviours

Comfort zone – you’re out of it. Think everyone is looking at you. You’re under the impression that you are acting odd. Think up hypothetical scenarios that you worry about. Put your guard up. Become introverted. Prior to a social gathering you imagine being crammed in at the bar, people in your way. You worry about what you will wear. If you will you look overweight because of your psych meds.

Results

Poor sleep – mind racing. Poor appetite – too tired/lethargic. Heightened blood pressure. Poor concentration – could possibly effect work, home relations with friends and family.

Factual Outcome

No amount of anxiety will have any impact on the outcome. When you finally go through that door you imagined was in front of you and you always thought was locked, you’ll look back over your shoulder and you’ll realise that there was never a door there in the first place.

Lithium Carbonate, Semisodium Valproate, Quetiapine and Mirtazapine 💊

It’s a heavy arsenal of Psych Meds I have accumulated wouldn’t you say? But this is the thing that you have to accept. Bipolar Disorder is an absolute Tyrant that has to be silenced. I’m lucky to have found a balance now it seems. I had to persist with my psychiatrist and justify to him why I wanted to be prescribed Lithium as well as the other meds. I was functioning before the lithium was introduced. I wasn’t showing any cause for concern so to speak so my psychiatrist was happy with my condition. However, I knew something wasn’t quite right with me. So I spoke to the Psychiatric Pharmacist at Mountcroft and explained to her about how things were and my thoughts. I’d done my research and put together my notes to show what the problem was, my hypothesis on the next step and then my justification for it and my conclusion. I wasn’t telling anyone how to do their job, I was just giving them the best explanation of how I felt. The pharmacist concurred with my proposal so it went back to my psychiatrist and he authorised my prescription. I’m also on Ramipril so there’s concerns for that raising lithium levels in the blood and causing toxicity. However, as I was already on the ramipril, the introduction of lithium could be boosted by it meaning that I may only need a lower dose than usual to hit the therapeutic zone.

It’s been 5 weeks now since I started the Lithium and I’m in a very, very content place at the moment. The best I have been for a long time. I have started to get a routine in place for the first time in as long as I can remember. There’s still a lot of things that I need to do but I’m on the right track with it. I’ve made enquiries about a few guitar lessons to make me pick it up again and blow away the cobwebs. I’ve stopped drinking alcohol and I’m on orange and soda now. To be honest though, I wasn’t a big drinker anyway. I drank shandy’s and only at weekends. Started back with my language learning, Portuguese and Spanish, because it is so easy to forget what you once knew. Got myself some clothes and donated the stuff I didn’t wear to the charity shop. I’ve also been trying to eat healthy foods. I’ve not quite figured this one out yet as I’m still putting weight on every week at my check up 😂

I makes you wonder though doesn’t it. Before the medication, before the psychiatric appointments, before the self harming, before the psychosis, before the mania, before the depression, when you are yourself and not labelled or diagnosed with this or that, you didn’t feel comfortable and felt that you weren’t like the other people around you. So you don’t know what to do. Social pressures and society can then push you further down the rabbit hole. After you break and go to the doctor, they don’t put you back together as you were. You are remodelled, your brain chemistry altered by drug after drug after drug to become someone that looks like you, but isn’t really you…

Thank you for your time reading this. Hope you have a wonderful weekend 🙌

Is There a Link Between Calcium Levels & Lithium Therapy In Bipolar Disorder

I’m on with my reading and research on Lithium and I have a question about something that I was hoping somebody may be able to share their knowledge on it with me.

Lithium in higher, therapeutic doses can inhibit the resynthesis of phosphatidylinostol diphosphate. This is why it is used for mania. Inositol triphosphate and diacylgylcerol are recombined after their tasks for the resynthesis. Inositol works on the calcium ion channels so I’m just wondering if there is a link between calcium levels having an impact on mania in bipolar, that in turn lithium remedies. Is there anything linking calcium to lithium?

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