Lamotrigine

And flying I still will not move

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I’m rushing.

I’m rushing and it’s beautiful.

Beautiful like fire and lashing rain and thunder and howling howling wind, I’m rushing and it’s beautiful and it’s taking my breath away.

Thank Christ at last I’m rushing and it’s beautiful, rather than hell.

Ideas whip into my head and hardly settle before being picked up spun around, turned about; impatient with myself and the world, plans that come to half a page of scribbled lines. And it feels good it feels good, you have no idea.

I want to just stay dancing in this whirlwind and laugh, and enjoy the storm.

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Hinterland

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Bad night’s sleep.

They all are, at the moment. I’m sleeping too much, going to bed too early, forcing me down. In a strange hinterland between hypomania and depression, occasional bursts of brilliance, usually in mornings or afternoon, but a low tone of anhedonia rising in the evenings. Jittery but bored.

The skin around my eyes is tight, I couldn’t be bothered to moisturise last night even as I was scratching at my eyes and watching flakes peel off. Fucking lamotrigine, I think. I’m glad I have the drug and it’s hardly S-J, but I’m fairly certain this sudden rush of psoriasis is because of the lamotrigine, fiddling about mysteriously with my immune system. Last night I found it was spreading, too. Doesn’t help that I reckon I need an increase.

This all sounds grim. I’m not grim. Just in a hinterland.

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Now, I am finally awake

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Plans that either come to naught

Or half a page of scribbled lines

– Pink Floyd, ‘Time’

You, but on a really good day

– Advertising slogan for Berocca vitamin drink

“Do you ever make plans?”

This seems a curious question from the psychiatrist. I assume he’s making a suggestion – maybe if I made more plans to do stuff, I’d feel less listless, less detached from life. Less like a spectator, bored by the spectacle.

“I do, sometimes. Nothing ever comes of it. All sorts of projects; I get a bit into them then nothing happens. I just forget about them, leave them to one side”

“Hmm”, he hmms.

It’s true, and it’s always frustrated me. I can never maintain focus long enough to see any of my projects through. It’s not just projects – those bursts of energy; after I quit Leeds uni (the first time), I spent about a month with a pristine bedroom, polished surfaces, reading voraciously about world religions and Buckminster Fuller (this is entirely reasonable; world religions are fascinating and it’s a good bit of cultural knowledge to have – and Buckminster Fuller was just an all round brilliant guy). Got into Timothy Leary and devoured the experience vaults on Erowid.

“It makes sense”, Emily commented recently, when I told her. “I’ve often felt quite jealous of the way you can seem so connected to the world”

It made it hard to believe I’d ever been really depressed. I was just being daft, dramatic. I carried on thinking that way about my depression until I was at least 24 – which is to say, almost 10 years since it first clearly emerged. Joy can delude as sure as despair. But the world just makes sense, you see? You just need to stop worrying, and let it all fall into place.

Around my 30th. My birthday’s in January and London was brisk and, in my mind, sunny. I’d just got a Kindle – present from brother #1 – and every now and then I’d see another with one. “Aren’t they great?!” I’d enthuse to them, shockingly unbritish. Spend a few minutes singing their praises with a complete stranger. And a sale in Habitat! Christ only knows how much I spent, but I don’t think I’ve ever been quite so delighted by homeware.

That stunning few weeks, a handful of years ago – looking gorgeous and feeling free. New clothes, new look, new body (seriously, I looked smoking). Fierce kissing and fucking; finally I’ve got this whole thing figured out.

(an aside – Clive Wearing’s diary, tragically timestamped, each erased line declaring ‘Now, I am finally awake‘)

And more recent – tellingly, just before my most recent fall; the grace was singing in me. All my neuroticism evaporated, the happy realisation that I’m fine, just me, myself. No need to worry about other’s opinions, other’s lives are not yardsticks with which to judge your own. Happy. Spring in my step and spring in the air, blossom, me blossoming out. Lab book filled with extraneous scribbles and commentary, flourishes. It all fell into place.

I compared all this, you see, to the ferocity of paroxetine. The hypomania induced by paroxetine was more probably mania – mania without grandiosity or delusion, but with a brilliant, blinding, childish energy; impatient, white water energy, all song and dance and singing and dancing, through the streets, cigarettes and cream. Bliss over every hair on my flesh, fluttering through every cell in my body. Bliss… bliss falling asleep, bliss upon waking. Bliss unlike any other. And compared to that – compared to that, everything else faded, everything else fades. Drugs, sex. Love. Nothing compares.

Setting such a high bar for hypomania, it’s no wonder I didn’t catch all these other moments. Or casually dismissed them, only accepting that SSRIs  pushed me into a very, very mild state.

Turns out my very, very mild state is actually just a state.

I keep taking the pills.

 

 

The promise of lust

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Partial list of side effects from citalopram information sheet I don’t know exactly when it shifted, and I definitely don’t know why. I tend to put a definite cut off around 2008, since the 2008-09 episode was so profound, lasted so long, and smothered me; like sleep, under morphine.

At first I blamed the drugs. That was comforting and easy, because after all a side effect of SSRIs is loss of libido. It also held out the promise that once I was off the drugs, I’d be up and running again. I was willing to put up with a flatlining sex drive for a while, for the relief the antidepressants gave me. They were only temporary, after all.

And then I came off the drugs, and I looked forward to the promise of torrential lust. Being young and gay in London with no strong desire for sex is… frustrating. I wanted that part of my life back. So I waited, and I waited, and it never came.

Oh sure, I could get drunk and horny. But that’s missing the point, isn’t it? Drunken lust is clumsy, grasping and loose. Temporary, and soon forgotten. Being young and gay in London with no strong desire for sex is more than a little alienating.

I still blamed the drugs, or maybe I blamed the depression, or both. Blamed some kind of permanent rewiring of the circuits of sexual desire. Maybe they’d burned out? Maybe they’d atrophied? We live in a culture saturated by sex – gay subcultures especially are sodden with it. But for all that, we seem to have little real regard for it. For most of us, sex is important, beyond hedonism and lust and beyond even passion. It’s important for contact, for happiness. For relationships and belonging and feeling a broad and deep range of emotion, sensation.

And I wasn’t getting any.

“Loss of libido” is thrown away in the patient information sheet which details side effects of SSRIs, alongside “failure to reach / maintain an erection (in men)”* and “Anorgasmia (failure to reach orgasm)”. I guess in the grand scheme of things, these aren’t profoundly worrying side effects – the other drug I’m on, lamotrigine, lists Stevens-Johnson syndrome (a potentially fatal loss of skin) and disseminated intravascular coagulation (DIC, AKA Death Is Coming) as it’s potential side effects. Yes, I’d rather have no sex drive and shit orgasms than die horribly from my skin sloughing from my body. Still. Hardly a fair comparison.

Sex is important. And when you’re prone to depression, not having a full – or any – sex life, and thus no romantic life, is dangerous. It denies you a source of pleasure, emotional soil in which to grip your roots to the world. “Protective factors”, in the dry but honest language of a psychiatric consultation. The fewer roots you have the more likely you are to wither. The easier it becomes to simply take the hand you’ve been dealt, and fold.

Sex is important. I really, really don’t think the wider psychiatric community appreciate just how important it is, largely oblivious to how antidepressants can deeply wound a life.

Of course, I’m human, and humans excel at making simple things complicated. Maybe the depression led to a plummeting libido. Maybe SSRIs turned down too many switches inside my head. But people are more complicated than just brains. After so long without a shag, the whole issue takes a life of it’s own, entwining with sexual confidence and body confidence, until it becomes impossible to know if you’re not having sex because you don’t want to, or because you’re afraid to.

I hope this problem is nice and simple and neurological. I hope my bottomed out libido can be blamed on a zapped out reward pathway, or a scrambled endocrine system, or anything other than high level psychology. Because if it’s up to psychology, I really can’t see it being resolved any time soon. Sex is important. Without it I don’t meet guys, I don’t date. I must be the only gay man in London who has never met anyone off Grindr. Seriously. My last online hookup was in 2008. This. Is getting. Tiring.

“Would you be open to a mood stabiliser?” The psychiatrist asks.

I’ve been rumbled. They want to take the hypomania from me.

“Which one?” I ask. They know I study neuroscience. It’s in the file. An awful lot is in the file.

“Lamotrigine”

I’ve heard of it, but beyond it being a mood stabiliser I know nothing. I don’t want the sluggishness that can come with some psychiatric meds (paroxetine destroyed me with sleep; and I’ve seen the effects of olanzapine – an antipsychotic – second hand). Will it place a final nail in the coffin of my libido? I’m wary. I want to know it’s mode of action, I want to know if…

“Like I say; I think the SSRIs work because they make me slightly hypomanic. If you take that away… What’s left?”

He reassures me; “just a trial”

It’s ultimately up to me. Naturally I go online and look up the mode of action (voltage gated sodium channel blocker, calcium channel blocker, glutamate modulator). I look up personal experiences.

Rise in libido.

Not everyone, not all the time. And sometimes the reverse – maybe it could be the final nail in the coffin. And sometimes the rise is due to activation of mania, sometimes fades after a few weeks. Still. It hangs there, glowing on my iPad screen. The promise of lust. Rise in libido.

I say yes.

I take the pill.

*Seriously, this is how it’s phrased. I love the fact they felt the need to specify.

Always be beautiful

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I feel…

I feel. You don’t know, you can’t know. How this feels. I feel.

Like…

Like the world…

No.

Like my heartbeat… Like my soul…

I feel the world, my heartbeat, my soul. I see this majesty, this glorious, wild, passionate world. I want to grab, to pull, to claw the world. To kiss. Deep. To leave my marks, red and raw and burning. Bloody, primal, rare.

To devour. This world dripping with promise and passion and fury and chaos and love, and love, and love, and lust.

I step from the pharmacy, holding a blister pack of lamotrigine in my hand, and look to the sky; a sunset glorious and impossible and free. A breeze teasing and sensual, and playful, and exultant. Clouds, golden, blazing.

I step from the pharmacy and look at the blister pack in my hand. Do you know how it feels? You can’t know. To feel so miserable, to feel to wretched and useless and bleak and ruined, to then see the world blossom out in breathless beauty; to move so swiftly from putrid misery to… to…

To this.

To glory.

And to be told this glory is folly, to be told to swallow these pills to take the fierce, untamed beauty from the world. To be told you must turn down Nirvana. Attenuate Heaven. You can’t know.

I walk, I smoke a cigarette. Catch the tube.

You can only hide so long. I suspected, ever since 2008, that the reason SSRI medication worked ‘so well’ for me was that they pushed me into a kind of hypomania. Paroxetine threw me into wild abandon – true mania, light speed and ecstatic and frightening and free; Sertraline, giddy and loose, the time I decided I needed to start dealing shares and learn Latin. Citalopram… Citalopram, like the bed of baby bear, just right. Citalopram, not too wild, just wild enough.

And yeah, sometimes I felt so free I could fly. Sometimes, even without the drugs, I could embark on wonderful new ideas and projects and schemes and it would always, always be beautiful. And I could dance in the street and dance in the gym because honestly, honestly, sometimes I can hear the music and feel the music, feel the music like a kiss. Not the gentle kiss of romance but music lustful, electric, abandoned; which grabs your neck and your body and pulls you in, devouring, devouring, hard and dangerous and fierce.

You give too much away, eventually. The records they keep are surprisingly detailed. “Would you be open to a mood stabiliser?” the psychiatrist asks. I say yes, eventually, for my own nefarious reasons.

Hypomanic episodes have less than ideal long term effects. Cognitive decline, possible neurological disruption. Still.

Still.

You can’t know how it feels. To be told this has to be taken from you, for your own good. The blinding brilliance of hypomania, when the world makes sense and you make sense and everything, oh everything is glorious, to be told everything that is glorious is a lie, the real world is a watery reflection, the real world a muted song. Take this pill. Save yourself. Turn down the world.

Would you take the pill?

I get off at Waterloo.

I take the pill.