So Am I Bipolar or Not? My Journey Through TelePsychiatry

So Am I Bipolar or Not? My Journey Through TelePsychiatry

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am i bipolarAlmost two years ago, when I lived in Palmdale, California, I experienced a major depression. I went to a community health center, which operates on a sliding scale basis. (In other words, I was a pauper without a PPO.) At the clinic, I saw a psychiatric nurse practitioner, which is cheaper for the clinic than having a shrink on board.

During the first session, I talked as if I was a baboon on speed and the nurse said that I exhibited signs of bipolar disorder. She prescribed me Depakote, a mood stabilizer often used to treat bipolar manic episodes.

That threw me off for a loop.

Many years earlier, back in 1999, my previous shrink had diagnosed me with obsessive-compulsive disorder, generalized anxiety disorder and depression. Throughout the years, I had taken different SSRI’s, including combinations of Celexa, Cymbalta, Prozac, Lexapro and Wellbutrin. We settled on a combination of Celexa and Cymbalta. My OCD, for the most part, went away. (In other words, I stopped performing repetitive rituals which included making sure that I had locked the door and that I had turned the stove off.) But I still suffered from a lingering sense of doom and depression, which was another reason why I self-medicated with booze.

Now I was bipolar?!

After having the Depakote filled at the local Walgreens, I ran home and sat in front of my computer. Googling the side effects of a medication can lead to frightening results. According a blog post titled “You Will Gain Weight on These 6 Psychiatric Medications,” Depakote was right there, in the top five.

That really terrified me. But other thoughts lingered on in my brain. 

How could a nurse practitioner diagnose me so quickly? My shrink had gone to Yale! Had this psychiatric nurse practitioner taken some online psychopharmacology classes? Why did she have an older, worn out version of the DSM in her office? Why didn’t she have the fifth edition? How did she know I was bipolar? She only met me three times!  

Well, I didn’t take the Depakote. I didn’t take anything, which made things worse. I made Dr. Jekyll and Mr. Hyde look like the Pope and Mother Teresa. I saw her a month later, and confessed that I’d never had a bipolar episode. Or had I? Why was I so damn stubborn?

“You have a lot of symptoms,” she said. “And you don’t sleep.”

“What about Celexa and Cymbalta?” I asked. “I took those for years.” I wanted to add, “And I didn’t get fat.” But I said nothing.

“Okay, “ she said. “But I am also going to prescribe Restoril, so you can sleep.”

I started taking those as prescribed.

I had no idea if the meds worked or not. My life was like a rollercoaster and my moods went along for the crazy ride. In other words, even though I was sober, I was broke and felt old and well, like crap. I would wonder: how the hell did I end up in the hideous Antelope Valley? When I was drinking all the time, I could overlook the fact that I had an Antelope Valley zip code. But when I got sober, I saw things clearly—maybe a little too clearly. Still, other times things like running, writing, or going to meetings made me feel happy.

Last May, I moved to the Mojave Desert with my pit bulls and Chihuahuas. I worked during the week. On the weekends, I slept all day with the stupid air conditioner on, huddled under two comforters surrounded by the dogs. At 7 pm I would rise like the Vampire Lestat and stay up all night devouring The New York Times online. This lasted for several months.

Was I bipolar after all?

While I was wrestling with this, I read a review of a Homeland season five episode. I wrote a comment, saying that I had a hard time believing that Carrie Matheson, played by Clare Danes, was bipolar. We always see Carrie “manic,” I pointed out, but how come we never see her depressed?

I was trying to figure out if I was manic depressive or just an extremely anxious and weird person. I still took the Celexa and Cymbalta, but stopped taking the Restoril because my dreams were just way too weird. Some days I felt happy, and other days I felt as prickly as the Joshua trees that surrounded my humble abode.

In December, I switched to an outpatient mental health clinic in the Mojave, because the nurse practitioner was still on leave. I saw a therapist, who gave me a slip to get blood work and a drug screening done. (They told me that was protocol, just in case I was popping benzos on the side—plus they wanted to make sure that I didn’t have any terminal illnesses.) After that, I received an appointment to see the sacred shrink.

When I arrived, a nurse led me into a room with only one chair, and left, shutting the door behind her.

I looked up and there was a TV screen, hanging from the wall. A man dressed in black leaned over a desk, and stared at a computer. My Netflix-riddled brain assumed the shrink was running late and I was in for an episode of The Mentalist.

The voice from the TV spoke.

“Hello, I am Dr. Chiu. Please have a seat.”

It turned out that Chiu was located in Long Beach, California. I found out later that the clinic used telepsychiatry because it was cheaper in the long run.

I told him I was there to discover if I was bipolar or not. I felt like Dorothy, minus Toto, talking to the Wizard of Oz.

“We shall see,” he responded, and started asking questions.

I told him that that I was a traumatized and recovering alcoholic who lived in the past. Even thought it was a video conference, I told him about relinquishing my son to my ex-husband when he was three or four, a fact that has really screwed me up. I told him about how chaotic my life had been in the last decade and how my dogs and I moved around like Barnum and Bailey’s Circus.

I couldn’t help but wonder what my life had come to. Back in the day, I’d sat in my psychiatrist’s beautiful office surrounded by Bonsai trees, Asian vases and beautiful rock water fountains. Now here I was staring at some 25-inch flat screen TV, talking to a shrink without a face.

After about an hour, he said, “I think you have an episodic mood disorder. Plus, it’s normal to have some anxiety over 50. But you look younger than your age.”

I wanted to tell him that I look young because he had horrible lighting and I couldn’t even make out his eyes or nose. “As for being over 50,” I imagined saying, “please don’t remind me. After I finish this appointment, I will shop next door at the Stater Brothers where I get to see all the sweet little old ladies congregating by the milk and yoghurt section, causing some serious traffic with their shopping carts.”

He described how alcoholics drink to cover their moods and explained that the disorders can develop after an alcoholic achieves sobriety. Honestly, by that point, he could have recommended a lobotomy and I would have grinned. I just wanted to run out of that airless room.

So for now, he decided, I should lose the Cymbalta, keep the Celexa and take Wellbutrin (which, he said, might not only curb my nicotine cravings but also cause weight loss).

After the session, I talked to my therapist. I told her what he’d said about Wellbutrin causing weight loss and asked her if I looked fat.

“No,” she said.

“It’s the camera,” I said. “It adds 20 pounds.”

We discussed the past, my self-esteem (which incidentally needs work) and the new meds. Finally she said, “I have observed that people who live in Boron, the Mojave, and California City are depressed. I had two clients who told me that they hated living in the desert. One killed herself.”

“Oh, my God,” I said. “So I am not bipolar? I have Mojave Melancholia?”

Afterwards, I went to Stater Brothers. And there they were: the sweet little old ladies hugged and laughed and hovered by the mayonnaise, ketchup and the jars of Calamata olives.

I decided to skip the olives, made a detour through the pet food section and resisted the urge to hurl a rawhide bone in the direction of aisle seven.

On the way home I contemplated the concept of Mojave Melancholia. I stopped at the gas station to buy cigarettes and saw that there were some cool postcards depicting my current hometown.

One postcard featured a Joshua tree. The other one had an image of the white wind turbines. I see them from my house, and at night they glow like a series of red UFO battleships about to attack planet Earth. Or maybe, I thought, they are just aiming laser beams at my house, in an effort to annihilate me, thus removing all traces of my Mojave Melancholia?

Oh, brother.

And then I remembered a line from The Big Book: “Nothing, absolutely nothing, happens in God’s world by mistake.”

Mojave Melancholia it is.

For now.

And I am faithfully taking the Wellbutrin 100 mg plus Celexa 40 mg.

As for the bipolar diagnosis, I guess more will be revealed.

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About Author

Sevasti Iyama is a recovering alcoholic, writer and photographer from the Bronx and LA. She has written a novel, From Bel Air to Welfare, and is currently penning her second one, The Holy Face Medal and Other Stories.