I have spent a good chunk of my life pondering one thing, which is how did I get to where I am today? I now have to rely on Ketamine to manage my mental health and can no longer benefit from traditional antidepressants due to their potential to trigger mania. Having had a chance to look back, I realize it dates back to my college years. Although I managed to get a lot of work done during that period, I was sleep-deprived and highly dependent on coffee in order to feel equipped to concentrate. When I graduated, I came home in a state of anxiety and burnout on an extreme level from everything I’d been through socially and academically on campus. The environmental factors, the challenge of living with a roommate on campus for the first and only time, and the fear of moving back in with my parents while trying to find an affordable place of my own caused a lot of stress. On top of all of these concerns, I’d had my antipsychotic reduced months earlier.
What I have now figured out when reflecting on that time is that no one around me, including my psychiatrist who had been treating me since I was ten, could tell that this was not just an intense level of anxiety, this was the brewing of mixed state that consisted of anxiety, irritability, and depression, which are all common in people on the spectrum, plus hypomania, which is a mild case of bipolar mania that tends to come and go so quickly that it’s hard for doctors to catch. In the two years leading up to my first hospitalization, I spent a year living with my parents, which was a depressing situation that created tension between me and almost my entire extended family and I was finding it difficult to get a job that paid. Despite that, when I was out with friends and my first-ever girlfriend I could usually avoid thinking about these serious issues. I now know that’s a common symptom when someone’s hypomanic. Over the course of the year that followed, I moved out of my parent’s place into a dorm-style apartment with a shared toilet and a dirty atmosphere. By the summer after this difficult period, my social life hit rock bottom because of the family tension and the end of my first relationship, but I had my own place and one dream of mine had come true, which was that I was a student at NYU finishing my master’s degree.
I was deprived of sleep and suffered burnout, but there was no room to be depressed about anything. The months leading up to my hospitalization were the happiest days I can remember because I was almost finished with my graduate degree. I had a second girlfriend that I stayed with for four years, but my health was falling apart because I was full-blown manic. The reason I’m now able to connect the dots between these different periods and mania as well as with antidepressants is that during the two-year period I just described, I aggravated right after I finished my bachelor’s when a new psychiatrist tripled my Prozac and put me on Adderall. This wasn’t the first time I’d tried a stimulant, but it was the first time taking me off it didn’t relieve the anxiety side effect. When I ended up being diagnosed as bipolar four years later, it was explained to me that antidepressants and stimulants can trigger mania in patients who are already afflicted with bipolar disorder.
I remained on the high Prozac dose until shortly before I was first hospitalized. The two more manic episodes that landed me in the hospital happened over the course of another year and a half led to my bipolar diagnosis were all aggravated by antidepressants and stimulants as were some hypomanic episodes later. It’s been nearly ten years and now I have to take higher doses of stronger antipsychotics and rely on Ketamine for depression, which some psychiatrists think may or may not cause mania. I’ve met several Ketamine specialists who have sworn it doesn’t, but some have acknowledged that if something else causes a patient to experience mania or hypomania, Ketamine can make it worse. What I also have found out recently from personal experience is that with lower doses of Ketamine, there is less anxiety and according to my doctor, lower doses are more effective for bipolar depression. In these last few months, my experience with lower doses has helped me stay calmer. However, I still suffer from a lack of sleep even though I’m working harder to get enough sleep. This presents itself as an important thing to take into consideration because sleep deprivation can be a big culprit for temporary periods of severe cases of anxiety, depression, and varying levels of hypomania or mania. Therefore, I need to be mindful of any hypomanic symptoms.
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