I’ve been so anxious at work, so depressed at home, that I haven’t had time to think through what I’ve been going through beyond, “gotta get outta here” and “gotta try something different with the meds.” Both are right, but I’ve been feeling like I’ve been living in tunnel vision for weeks.

I had a brief talk with my immediate boss about the crazy and abusive behavior of the big boss, which has been the cause of my sleepless nights and anxious, teary days, and when posed the either/or of “should I take a leave, or just quit?” he was strongly in the leave camp, but added, “I have enough bad karma to be mad at you if you left. You have to decide what’s healthy, what you can put up with.” So that was a bit of a relief, because other things aside, I’d hate to never speak with him again if I left.

I also had some “progress” on the headache/dizziness/depression front, in that I had a head CT (negative) and a long talk with my lovely shrink about my past month & a half. She thinks it’s a metabolic reaction of the lamictal with the increased effexor. Since I’d had occasional migraines on the lamictal before this recent dose increase, she thinks I need to come off it. I’m not happy about that– because within four days of starting the lamictal last June, when I was in the depths of despair, it had kicked in, and literally was a lifesaver. I hate to let go of something to which I owe so much gratitude, sanity, creativity, and joy. But at the same time, it’s not working anymore. The headaches and dizziness are getting worse, not better, and I can’t tolerate them and try to work, or figure out what to do about work, at the same time. So we talked about other options, and she wants me to consider lithium or Depakote.

I’m frightened of both. Lithium, because my father had a girlfriend who was manic-depressive, on lithium, and still not controlled. I know I’m a different case, and that it’s the gold standard for a reason, but that past experience continues to taint me. At the same time, though? The weight gain effects of Depakote terrify me. I’m a former bulimic, have a huge comfort-eating problem, and a massive oral fixation to boot. No pen cap is safe around me. I will always have issues with my weight, even though I’ve been pretty ok the last 10 years. At the same time, though, my mother and my aunt, who if you saw us all together in a photo, you would automatically know we’re related? Both over 250 lbs. And that’s without Depakote. I’m terrified of what would happen, even with trying my best.

Also, a really whiny, self-indulgent part of me does not want to give up my nightly glass of wine. Alchohol is a lot more contraindicated with these two drugs than with the lamictal, and I just don’t want to give my wine up. But if I have to, I have to. I actually defended a doctor years ago in a case where a bipolar on lithium ended up with tardive dyskinesia, a parkinson’s like neurological deterioration, because she was an alcoholic and continued drinking all the years she took the lithium. She was pretty much wheelchair-bound by the time the case made it to trial.

And the last part? I am terrified about what will happen to my mood during the taper down. I have a lot of work scheduled in the next month– I don’t want to hand it off, because these are my personal clients, not the firm’s, and at this point, I sort of feel like they’re all that I’ve got. But at the same time, it’s going to suck, to put it mildly, decreasing the lamictal to zero, then starting the lithium. (She doesn’t want to do a “close taper,” because there isn’t a lot of research on it since lamictal is still new in the bipolar formulary.) My husband asked me if I was going to take the end of the lamictal taper off, and it tells you how tunnel-visioned I am that it simply didn’t occur to me to reschedule stuff that week, rather than hand it off. It’s true that “I will be out that week for medical reasons, and need to reschedule.” No one else needs to know more.

It’s all too much, or almost too much, but it’s got to be done anyway, and I am scared shitless. I just hope that in response to all the resumes I am sending out, I don’t get a crucial interview on what might turn out to be a dream job, the week I’m off my mood stabilizer, and starting another. That would be a little too interesting.