An Unquiet Mind

I went directly from Touched With Fire to Dr. Lay Redfield Jamison’s An Unquiet Mind: A Memoir of Moods and Madness, her chronicle of her own battle with manic-depressive disorder and how it informed her career in mental health. Her candor about the extremities of her illness, and the criticality of maintaining medication upon diagnosis has given me much to think about.

My subject is how my own creative thought and action has been impacted by the illness and the medications I have taken. I am on an extremely low does of Risperidone (0.25 mg), and I question whether that is in part the cause of the collapse of my creative life. I am not Bipolar I, the extreme form. For all my excess and outlandish behaviors, I have never had a psychotic break. I believe I experienced a form of paredoila, seeing an old man’s face and a boar in the folds as the base of oak trees during my longs walks after precipitously quitting my job in 2015. When I walk the same paths I can’t see them clearly anymore. But there was nothing approaching hallucination.

My depressions were not the paralysis of despair. I was floating in a boat on still and windless gray sea at times, but never tempted to jump overboard. Some of my depression may have equally had roots in life experiences. I used to tell a prior pill doctor and the psychiatrist who helped me off Klonopin (and who first diagnosed me correctly) that given some of my life experiences in the past decade and more, I’d be a psychopath not to be depressed.. I currently take 20mg of generic Prozac. In the past I was given citalopram and buproprion. After reading about Dr. Jamison’s experience with discontinuing Lithium, I am increasingly inclined to continue my small dose of Risperidone, and consider whether I truly need to still be taking an SSRI after five years of remission, and ten years total taking them.

Something shut off the creative part of my brain, and I’m not entirely convinced it was solely remission of bipolar disorder. I always prided myself on my vocabulary, and yet I frequently find myself looking up words that I know I know. I noted above how my ability read, enjoy and analyze poetry evaporated with my remission, and how I turned to easier genre fiction. I just read Beloved because of the recent controversy, and it was a difficult slog. And I always enjoyed Faulker and Joyce re-reading Ulysses every other June or so. I feel like my concentration is strained in my sometimes complex work life in which I test computer software. My prior psychiatrist thought perhaps ADHD was keeping my associative though from organizing itself, and I was on guanfacine for a long while, and don’t recall precisely why I discontinued it. My general recollection is I went off that about the time of my bipolar diagnosis, and began transitioning away from Klonopin and toward the anti-seizure sort of medication.

It is possible what i am experiencing is just a factor of my age (64), but I desperately want to know if I’m drifting toward some form of dementia, or whether I am bringing it on myself through medication. To extend a person without advance statistical and methodological training can decode medical journal articles, a few things jump out at me:

• There is evidence that long-term use of SSRIs for anxiety disorder may impact cognitive function..
• There is evidence that Bipolar Disorder is associated with cognitive impairment, but the studies have been on mostly BP1 and/or inpatients, i.e., people with extremely acute conditions.
• Long term studies starting in childhood indicate that people with subsequent BP disorder often have higher cognitive function earlier in life.

What I cannot find is any study that looks like the difference between treated and untreated individuals, probably because if you’re an inpatient you are having severe, schizophrenic symptoms. I don’t see anything that looks specifically at the treatments such as anti-psychotics as possible actors in decline in cognitive function separate from the disease.

At this point, my dosage of Risperidone is very low — 0.25 mg a day — so for now my inclination is to continue that medication to avoid some of my past, unhealthy behaviors. As extended use of SSRIs might affect cognition, I’m going to start by titrating off of Prozax.

I’m not exactly excited about discontinuing the Prozac. I’ve experienced a brain zap and it’s a startling and unpleasant experience. But SSRIs are also associated with some decline of cognitive function, and I think that is where I will take the conversation with my psychologist. If I have to worry about dementia in my old age as an unavoidable process, I’d rather start addressing that now. And I believe reducing my intake of psychotropic drugs is an important first step on eliminating those as a cause.